Provider Demographics
NPI:1922794544
Name:WOHLFORD, KIASHA MAKIA
Entity Type:Individual
Prefix:
First Name:KIASHA
Middle Name:MAKIA
Last Name:WOHLFORD
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 1:2425 S LINDEN RD STE D138
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5482
Mailing Address - Country:US
Mailing Address - Phone:810-339-6942
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD STE D138
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5482
Practice Address - Country:US
Practice Address - Phone:810-339-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty