Provider Demographics
NPI:1538787189
Name:NOWELL, KERENSA EVETTE (NP)
Entity type:Individual
Prefix:
First Name:KERENSA
Middle Name:EVETTE
Last Name:NOWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERENSA
Other - Middle Name:EVETTE
Other - Last Name:NOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:416 ANDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EVERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76140-4102
Mailing Address - Country:US
Mailing Address - Phone:817-798-0432
Mailing Address - Fax:
Practice Address - Street 1:416 ANDENWOOD DR
Practice Address - Street 2:
Practice Address - City:EVERMAN
Practice Address - State:TX
Practice Address - Zip Code:76140-4102
Practice Address - Country:US
Practice Address - Phone:817-798-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPI145216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty