Basic Information
| Provider Information | |||||||||
| NPI: | 1194719153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | KWAME | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 MDG/AMDS | ||||||||
| Address2: | 303 FISHER ST, BLDG 468 | ||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283760420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2501 CAPEHART RD | ||||||||
| Address2: | |||||||||
| City: | OFFUTT AFB | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681131043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022947376 | ||||||||
| FaxNumber: | 4022949984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 51577 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.