Provider Demographics
NPI:1295321537
Name:ALEXANDER, KENYATTA NESCHELLE
Entity type:Individual
Prefix:MS
First Name:KENYATTA
Middle Name:NESCHELLE
Last Name:ALEXANDER
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 1:1211 TECH BLVD STE 110
Mailing Address - Street 2:SUITE 110 MB 14
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7846
Mailing Address - Country:US
Mailing Address - Phone:253-359-0491
Mailing Address - Fax:253-793-9090
Practice Address - Street 1:1211 TECH BLVD
Practice Address - Street 2:SUITE 110 # 14
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:253-359-0491
Practice Address - Fax:253-793-9090
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)