Provider Demographics
NPI:1538325204
Name:WILEY, KAMANONIE LATISHA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KAMANONIE
Middle Name:LATISHA
Last Name:WILEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:281-920-3283
Mailing Address - Fax:281-493-0191
Practice Address - Street 1:2470 S DAIRY ASHFORD ST
Practice Address - Street 2:137
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5716
Practice Address - Country:US
Practice Address - Phone:281-920-3283
Practice Address - Fax:281-493-0191
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health