Provider Demographics
NPI:1538938089
Name:FRIERSON, STARRKENYA KHADIJA
Entity type:Individual
Prefix:
First Name:STARRKENYA
Middle Name:KHADIJA
Last Name:FRIERSON
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-0840
Mailing Address - Country:US
Mailing Address - Phone:951-427-7502
Mailing Address - Fax:
Practice Address - Street 1:14567 SCHOONER DR
Practice Address - Street 2:
Practice Address - City:HELENDALE
Practice Address - State:CA
Practice Address - Zip Code:92342
Practice Address - Country:US
Practice Address - Phone:951-427-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA718795164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse