Provider Demographics
NPI:1285434191
Name:BOOKER, KIYWAUN
Entity type:Individual
Prefix:
First Name:KIYWAUN
Middle Name:
Last Name:BOOKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W 3RD ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6844
Mailing Address - Country:US
Mailing Address - Phone:937-409-6258
Mailing Address - Fax:
Practice Address - Street 1:1119 W 3RD ST APT 2B
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6844
Practice Address - Country:US
Practice Address - Phone:937-409-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker