Provider Demographics
NPI:1710706643
Name:FENTRESS, KENYA MICHELLE
Entity type:Individual
Prefix:MS
First Name:KENYA
Middle Name:MICHELLE
Last Name:FENTRESS
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 1:19908 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1232
Mailing Address - Country:US
Mailing Address - Phone:313-651-6861
Mailing Address - Fax:
Practice Address - Street 1:19908 LAHSER RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1232
Practice Address - Country:US
Practice Address - Phone:313-651-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula