MEDICARE: A FULFILLING LIFE

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	164W00000X	Licensed Practical Nurse
2	163WG0000X	General Practice Registered Nurse

General Provider Information

NPI Number	:	1396693909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FULFILLING LIFE

Provider Business Mailing Address
First Line	:	3000 W MASTER ST APT 408
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4416
Country	:	US
Telephone Number	:	215-416-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W MASTER ST APT 408
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-4416
Country	:	US
Telephone Number	:	215-416-8664
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KENYA KENYATTA REED
Credential	:	MS
Telephone Number	:	215-416-8664

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “A FULFILLING LIFE ” Practice Location

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