Organization
SUN KYSS GLO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARA S VINCENT (OWNER)
(954) 873-4433
Entity
Organization
Contact information
Practice address
27 CHOCTAW CENTER, CHEROKEE VILLAGE, AR 72529-2702
(954) 873-4433
Mailing address
27 CHOCTAW CENTER, CHEROKEE VILLAGE, AR 72529-2702
(954) 873-4433
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
05/14/2021
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