Provider Demographics
NPI:1962082552
Name:FLEMING, KYANNI N (RN, LMT)
Entity type:Individual
Prefix:
First Name:KYANNI
Middle Name:N
Last Name:FLEMING
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N ROLLING RD STE 305
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4142
Mailing Address - Country:US
Mailing Address - Phone:443-203-8308
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 305
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4142
Practice Address - Country:US
Practice Address - Phone:443-203-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156255163WM1400X
MDM04061225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)