Provider Demographics
NPI:1245936202
Name:WINGSTER, KENESHEIA (C TRICHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:KENESHEIA
Middle Name:
Last Name:WINGSTER
Suffix:
Gender:F
Credentials:C TRICHOLOGIST
Other - Prefix:MS
Other - First Name:KERNESHEIA
Other - Middle Name:
Other - Last Name:WINGSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C TRICHOLOGIST
Mailing Address - Street 1:9980 PIN POINT AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-8565
Mailing Address - Country:US
Mailing Address - Phone:912-515-9025
Mailing Address - Fax:
Practice Address - Street 1:5002 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4512
Practice Address - Country:US
Practice Address - Phone:912-515-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO091234174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty