Provider Demographics
NPI:1518565324
Name:AARON, KANISHA TONYA
Entity Type:Individual
Prefix:
First Name:KANISHA
Middle Name:TONYA
Last Name:AARON
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 1:9401 GROVETON CIR APT 311
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-8299
Mailing Address - Country:US
Mailing Address - Phone:443-858-1399
Mailing Address - Fax:
Practice Address - Street 1:9401 GROVETON CIR APT 311
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-8299
Practice Address - Country:US
Practice Address - Phone:443-858-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily