Provider Demographics
NPI:1598478869
Name:K & D TRANSPORTATION SERVICE LLC
Entity Type:Organization
Organization Name:K & D TRANSPORTATION SERVICE LLC
Other - Org Name:SHUWANDA GATLIN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TRANSPORTATION
Authorized Official - Prefix:
Authorized Official - First Name:SHUWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DRIVEN
Authorized Official - Phone:601-730-8645
Mailing Address - Street 1:69 GINNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-5597
Mailing Address - Country:US
Mailing Address - Phone:601-730-8645
Mailing Address - Fax:
Practice Address - Street 1:69 GINNTOWN RD
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-5597
Practice Address - Country:US
Practice Address - Phone:601-730-8645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587411761Medicaid