Active NPI
Kavon Wilson
- Home Health Agency
- Suitland, MD
National Provider Identifier
1992434245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 3807 St. Barnabas Rd. #104
Suitland, MD 20746 - Phone
- (202) 394-4579
- NPI assigned
- Jun 9, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | DC | Primary |
Addresses
Primary practice location
3807 St. Barnabas Rd. #104
Suitland, MD 20746
Mailing address
3807 St. Barnabas Rd. #104
Suitland, MD 20746
Phone (202) 394-4579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4549360 | Medicaid | DC |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1992434245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3807 ST. BARNABAS RD. #104",
"city": "SUITLAND",
"state": "MD",
"postal_code": "20746",
"telephone_number": "202-394-4579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3807 ST. BARNABAS RD. #104",
"city": "SUITLAND",
"state": "MD",
"postal_code": "20746",
"telephone_number": "202-394-4579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KAVON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-09",
"last_updated": "2022-06-09",
"certification_date": "2022-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "DC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4549360",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Suitland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.