Provider Demographics
NPI:1962968362
Name:BRINSON, KIAWNA CHEZ
Entity type:Individual
Prefix:
First Name:KIAWNA
Middle Name:CHEZ
Last Name:BRINSON
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 1:101 HERONS CV
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3487
Mailing Address - Country:US
Mailing Address - Phone:757-769-5801
Mailing Address - Fax:
Practice Address - Street 1:101 HERONS CV
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3487
Practice Address - Country:US
Practice Address - Phone:757-769-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANONEOtherNONE