Provider Demographics
NPI:1407664899
Name:CORLEY, KIMALI QUTINA
Entity type:Individual
Prefix:
First Name:KIMALI
Middle Name:QUTINA
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-0245
Mailing Address - Country:US
Mailing Address - Phone:347-872-5232
Mailing Address - Fax:
Practice Address - Street 1:2850 WEBB AVE APT 7G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2141
Practice Address - Country:US
Practice Address - Phone:347-872-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula