Provider Demographics
NPI:1144827726
Name:PAGE, KENNISHEWA LEWIS
Entity type:Individual
Prefix:
First Name:KENNISHEWA
Middle Name:LEWIS
Last Name:PAGE
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 1:82 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2826
Mailing Address - Country:US
Mailing Address - Phone:304-429-9594
Mailing Address - Fax:
Practice Address - Street 1:82 SMITH DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2826
Practice Address - Country:US
Practice Address - Phone:304-429-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant