MEDICARE: KEY TO WELLNESS & HEALTH BY KT, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1922824416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEY TO WELLNESS & HEALTH BY KT, LLC

Provider Business Mailing Address
First Line	:	16821 BUCCANEER LN STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2512
Country	:	US
Telephone Number	:	832-308-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	16821 BUCCANEER LN STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2512
Country	:	US
Telephone Number	:	832-308-5053
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANISHA M STEVENS- BROWN
Credential	:	RN
Telephone Number	:	832-308-5053

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	11/29/2024

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