MEDICARE: KYLENE CHAVIS RRT

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	227900000X	Registered Respiratory Therapist	6675	NC
2	1041C0700X	Clinical Social Worker	PO21419	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154889913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLENE CHAVIS RRT

Provider Business Mailing Address
First Line	:	4657 PROSPECT RD
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-9051
Country	:	US
Telephone Number	:	910-391-9470
Fax Number	:

Provider Business Practice Location Address
First Line	:	4685 PROSPECT RD
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-9051
Country	:	US
Telephone Number	:	910-391-9470
Fax Number	:

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

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	10/23/2024

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Directions to “ KYLENE CHAVIS RRT” Practice Location

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