Provider Demographics
NPI:1700631926
Name:OUTLAW, KISHNA MARIE
Entity Type:Individual
Prefix:
First Name:KISHNA
Middle Name:MARIE
Last Name:OUTLAW
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 1:3524 E ANDRADA RD
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9341
Mailing Address - Country:US
Mailing Address - Phone:404-599-1725
Mailing Address - Fax:
Practice Address - Street 1:3524 E ANDRADA RD
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9341
Practice Address - Country:US
Practice Address - Phone:404-599-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula