Khandra Aries Ivy
Technician, Pathology, Phlebotomy in Okolona, MS. Individual provider (NPI-1).
NPI number1063199750
StatusActive
Last updated in NPPESJul 3, 2023
Details
- NPI
- 1063199750
- Entity type
- Individual (NPI-1)
- Name
- Khandra Aries Ivy
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 3, 2023
- Certification date
- Jul 3, 2023
- Last updated
- Jul 3, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246RP1900X | Technician, Pathology, Phlebotomy | – | – | Yes |
Other names
- Khandra Aries Ivy (Other Name)
Practice location
127 Drive 156Okolona, MS 38860-9677
Phone 662-760-3031
Mailing address
127 Drive 156Okolona, MS 38860-9677
Phone 662-760-3031
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