Provider Demographics
NPI:1922848639
Name:EXUM, KENISHA (LPN)
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:
Last Name:EXUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLD SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7712
Mailing Address - Country:US
Mailing Address - Phone:252-902-7338
Mailing Address - Fax:
Practice Address - Street 1:622 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2854
Practice Address - Country:US
Practice Address - Phone:919-910-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80926164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse