Provider Demographics
NPI:1487193306
Name:BULLOCKS-JOSEPHS, KIONA RENEE
Entity Type:Individual
Prefix:
First Name:KIONA
Middle Name:RENEE
Last Name:BULLOCKS-JOSEPHS
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 1:3516 13TH ST SE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4426
Mailing Address - Country:US
Mailing Address - Phone:240-535-6011
Mailing Address - Fax:
Practice Address - Street 1:3516 13TH ST SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4426
Practice Address - Country:US
Practice Address - Phone:240-535-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide