MEDICARE: KENYA HUNTER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144674722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENYA HUNTER

Provider Business Mailing Address
First Line	:	5841 GOLD HORIZON ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6882
Country	:	US
Telephone Number	:	213-670-0981
Fax Number	:	702-917-2227

Provider Business Practice Location Address
First Line	:	5841 GOLD HORIZON STREET
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	702-917-2227
Fax Number	:	702-802-2144

Authorized Official
Title or Position	:	SELF
Name	:	KENYA HUNTER
Credential	:
Telephone Number	:	213-570-0981

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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