Individual
KIANNA FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
97 ELMIRA ST SW, WASHINGTON, DC 20032-2248
(202) 670-4860
Mailing address
97 ELMIRA ST SW, WASHINGTON, DC 20032-2248
(202) 670-4860
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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