MEDICARE: KELLY ANYE MIYANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN1049566	DC

General Provider Information

NPI Number	:	1104185149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANYE MIYANG

Provider Business Mailing Address
First Line	:	2041 MARTIN LUTHER KING JR AVE SE STE M1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7004
Country	:	US
Telephone Number	:	202-610-9560
Fax Number	:	202-610-9561

Provider Business Practice Location Address
First Line	:	1818 NEW YORK AVE NE STE 110
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1849
Country	:	US
Telephone Number	:	202-489-0615
Fax Number	:	202-379-9220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	12/08/2023

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