Active NPI
Khanisa Cunningham, CRC
- Driver
- Maumee, OH
National Provider Identifier
1720747918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- SL171281
- Practice address
- 715 Kingsbury St
Maumee, OH 43537-1823 - Phone
- (937) 219-3394
- Fax
- (866) 203-4192
- NPI assigned
- Dec 15, 2021
- Last updated
- Dec 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | SL171281 | OH | Primary |
Addresses
Primary practice location
715 Kingsbury St
Maumee, OH 43537-1823
Mailing address
8569 Stone Oak Dr
Holland, OH 43528-8197
Phone (937) 219-3394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL171281 | OH | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639526400000",
"number": "1720747918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8569 STONE OAK DR",
"city": "HOLLAND",
"state": "OH",
"postal_code": "435288197",
"telephone_number": "937-219-3394",
"fax_number": "866-203-4192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 KINGSBURY ST",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371823",
"telephone_number": "937-219-3394",
"fax_number": "866-203-4192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "KHANISA",
"name_prefix": "Mrs.",
"credential": "CRC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-15",
"last_updated": "2021-12-15",
"certification_date": "2021-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "OH",
"license": "SL171281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.