MEDICARE: KALI WISE

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1558092841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALI WISE

Provider Business Mailing Address
First Line	:	5480 SHAWNEE CIR APT 5
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25705-3332
Country	:	US
Telephone Number	:	304-205-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 RIVERVIEW DR
Second Line	:
City	:	TORNADO
State	:	WV
Zip	:	25202-9716
Country	:	US
Telephone Number	:	304-767-5852
Fax Number	:

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

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	06/18/2022

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Directions to “ KALI WISE ” Practice Location

Language	Start Address	Practice Location

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