Provider Demographics
NPI:1033429303
Name:PHILIPS, KENYA KIMESHA (RN)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:KIMESHA
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 TORMES
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:972-697-9592
Mailing Address - Fax:
Practice Address - Street 1:2580 W CAMP WISDOM RD
Practice Address - Street 2:SUITE 100-146
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-697-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX743388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse