Provider Demographics
NPI:1437600616
Name:FENTON, KALEIGH MARIE
Entity type:Individual
Prefix:MRS
First Name:KALEIGH
Middle Name:MARIE
Last Name:FENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KALEIGH
Other - Middle Name:MARIE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2602 WESTRIDGE AVE W APT S304
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-8271
Mailing Address - Country:US
Mailing Address - Phone:636-524-5445
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:ATTN: MCHJ-CLQ-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146076376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide