Provider Demographics
NPI:1649877911
Name:NKAAH, KIYAH
Entity type:Individual
Prefix:
First Name:KIYAH
Middle Name:
Last Name:NKAAH
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 1:3207 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4971
Mailing Address - Country:US
Mailing Address - Phone:240-722-8096
Mailing Address - Fax:240-722-8096
Practice Address - Street 1:3207 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4971
Practice Address - Country:US
Practice Address - Phone:240-722-8096
Practice Address - Fax:240-722-8096
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00171924376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide