Provider Demographics
NPI:1043982861
Name:WILSON, KANDRIA MONEA
Entity type:Individual
Prefix:
First Name:KANDRIA
Middle Name:MONEA
Last Name:WILSON
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 1:3734 LAKE LA BERGE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4396
Mailing Address - Country:US
Mailing Address - Phone:225-354-9298
Mailing Address - Fax:
Practice Address - Street 1:3734 LAKE LA BERGE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4396
Practice Address - Country:US
Practice Address - Phone:225-354-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)