Provider Demographics
NPI:1750152971
Name:CUTHBERTSON, KISHA LASHA
Entity type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:LASHA
Last Name:CUTHBERTSON
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 1:1645 ARLYN CIR APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3688
Mailing Address - Country:US
Mailing Address - Phone:704-904-2945
Mailing Address - Fax:
Practice Address - Street 1:1645 ARLYN CIR APT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3688
Practice Address - Country:US
Practice Address - Phone:704-904-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)