Provider Demographics
NPI:1801650965
Name:CHENAULT, DESHA
Entity type:Individual
Prefix:
First Name:DESHA
Middle Name:
Last Name:CHENAULT
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 1:116 RAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1456
Mailing Address - Country:US
Mailing Address - Phone:859-327-9336
Mailing Address - Fax:
Practice Address - Street 1:116 RAND AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1456
Practice Address - Country:US
Practice Address - Phone:859-327-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174200000X, 253Z00000X
251B00000X, 342000000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No342000000XTransportation ServicesTransportation Network Company
No347E00000XTransportation ServicesTransportation Broker