Provider Demographics
NPI:1356975742
Name:KOUYATE, KAREN SHIRELLE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SHIRELLE
Last Name:KOUYATE
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 1:6120 GEORGIA AVE NW APT 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5169
Mailing Address - Country:US
Mailing Address - Phone:202-412-4688
Mailing Address - Fax:
Practice Address - Street 1:6120 GEORGIA AVE NW APT 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5169
Practice Address - Country:US
Practice Address - Phone:202-412-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HHA14996251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health