Provider Demographics
NPI:1972065696
Name:WILLS, KURTISA KY'LEAF
Entity Type:Individual
Prefix:MS
First Name:KURTISA
Middle Name:KY'LEAF
Last Name:WILLS
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 1:2319 HARTFORD ST SE APT 302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7920
Mailing Address - Country:US
Mailing Address - Phone:202-573-1539
Mailing Address - Fax:
Practice Address - Street 1:1751 STANTON TER SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2823
Practice Address - Country:US
Practice Address - Phone:202-907-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion