Haika Gloria Kisamo

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

RN270976 Issued in GA

Practice address

811 Kennesaw Ave NW
Marietta, GA 30060-1002

Phone

(770) 422-2451

NPI assigned

Aug 8, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Mso LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1952196164
  Medicare reassignment NPD
• Hardy Renew Wellness,LLC

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1952914368
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1528741436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5323 WHITEHAVEN PARK LN SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265957",
            "telephone_number": "832-818-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601002",
            "telephone_number": "770-422-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISAMO",
        "first_name": "HAIKA",
        "middle_name": "GLORIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN270976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dean M. Kirkel, MD
• Marjan Zarif Kirkland, FNP-C
• Elizabeth R Kirkley, C.N.M.
• Teri Danielle Kirkpatrick, PT
• Lucy Kirumba
• Melissa Lamb Kiser, NP
• Megan Michelle Kistler, PA
• Harriet Kisuve, NP
• KJ Headlee Chiropractic LLC
• Carmen Manuela Klass, MD, PHD

• Primary Care Nurse Practitioner in Marietta, GA
• Providers in Marietta, GA by specialty
• Primary Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.