Provider Demographics
NPI:1750685137
Name:COTTON, KISHIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:KISHIA
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KISHIA
Other - Middle Name:
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:820 COLGATE AVE
Mailing Address - Street 2:#17F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4861
Mailing Address - Country:US
Mailing Address - Phone:718-589-8199
Mailing Address - Fax:
Practice Address - Street 1:820 COLGATE AVE
Practice Address - Street 2:#17F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4861
Practice Address - Country:US
Practice Address - Phone:718-589-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296688-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse