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General NPI Number Information
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NPI Number | 1669127379
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Entity Type | Organization
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Legal Business Name | K&MT
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 411 E INDIAN SCHOOL RD APT 2119
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City | PHOENIX
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State | AZ
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Zip | 85012-1886
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Country | US
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Telephone | 480-241-2197
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 E MEADOWBROOK AVE APT 346
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City | PHOENIX
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State | AZ
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Zip | 85016-5113
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Country | US
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Telephone | 480-241-2197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA WILSON
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Credential |
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Telephone | 480-241-2197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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