Provider Demographics
NPI:1902441330
Name:ALEXANDER, KENYA MARSHALL (LPN)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:MARSHALL
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-0049
Mailing Address - Country:US
Mailing Address - Phone:757-894-5587
Mailing Address - Fax:
Practice Address - Street 1:7080 CHINCOTEAGUE LN
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3838
Practice Address - Country:US
Practice Address - Phone:757-894-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN083700364SH0200X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health