Kylene Chavis, RRT
Individual provider Active NPI Clinical Social Worker · Maxton, NC
NPI 1154889913 · NPPES record last updated Oct 23, 2024
Key facts
- NPI
- 1154889913
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- PO21419 (NC)
- Practice address
- 4685 Prospect Rd
Maxton, NC 28364-9051 - Phone
- (910) 391-9470
- NPI assigned
- Mar 11, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO21419 | NC | MD | Clinical Social Worker |
| 6675 | NC | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Respiratory Therapist | 227900000X | 6675 | NC | |
| Clinical Social Worker | 1041C0700X | PO21419 | NC | Yes |
Addresses
Primary practice location
4685 Prospect Rd
Maxton, NC 28364-9051
Mailing address
4657 Prospect Rd
Maxton, NC 28364-9051
Phone (910) 391-9470
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SSN | Medicaid | NC |
Other providers in Maxton, NC
- Bettina Bullard
- Jabrie Bullard
- Janet Marie Campbell
- Care Ride Express
- Chaparral Youth Services
- Choice Imaging, LLC
- Katelynn Clark
- John R Clay I
- Kimberly Suzanne Collins
- Ashley Cheree Cooper
All providers in Maxton, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.