Provider Demographics
NPI:1578456687
Name:EMENIKE, KINGSLEY I (BSN)
Entity type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:I
Last Name:EMENIKE
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 19TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-4321
Mailing Address - Country:US
Mailing Address - Phone:908-251-2762
Mailing Address - Fax:
Practice Address - Street 1:1614 19TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4321
Practice Address - Country:US
Practice Address - Phone:908-251-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 251J00000X, 251S00000X, 251T00000X, 372500000X, 373H00000X, 385HR2060X, 3747A0650X, 376J00000X, 385H00000X, 385HR2065X
NDR49734163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No372500000XNursing Service Related ProvidersChore Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child