MEDICARE: KENYATTA MCKINLEY WASHINGTON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1467298026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYATTA MCKINLEY WASHINGTON

Provider Business Mailing Address
First Line	:	9902 FOX RUN DR
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-3071
Country	:	US
Telephone Number	:	240-832-1976
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 FORT DUPONT ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6035
Country	:	US
Telephone Number	:	202-575-4848
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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