Provider Demographics
NPI:1073121455
Name:COLE, KIYONNA
Entity Type:Individual
Prefix:
First Name:KIYONNA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 S FORT APACHE RD STE 215-164
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1719
Mailing Address - Country:US
Mailing Address - Phone:702-432-1333
Mailing Address - Fax:
Practice Address - Street 1:222 S RAINBOW BLVD STE 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5356
Practice Address - Country:US
Practice Address - Phone:702-423-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health