Provider Demographics
NPI:1366682114
Name:KAMANONIE L. WILEY
Entity Type:Organization
Organization Name:KAMANONIE L. WILEY
Other - Org Name:PROJECT STARZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAMANONIE
Authorized Official - Middle Name:LATISHA
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:504-235-9247
Mailing Address - Street 1:2470 S DAIRY ASHFORD ST
Mailing Address - Street 2:137
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5716
Mailing Address - Country:US
Mailing Address - Phone:832-892-9089
Mailing Address - Fax:713-995-5356
Practice Address - Street 1:8300 BISSONETT
Practice Address - Street 2:315
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5716
Practice Address - Country:US
Practice Address - Phone:832-892-9089
Practice Address - Fax:713-995-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0123703747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty