Provider Demographics
NPI:1033747787
Name:KEMBEL, SHENAE MARCENE
Entity Type:Individual
Prefix:MRS
First Name:SHENAE
Middle Name:MARCENE
Last Name:KEMBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHENAE
Other - Middle Name:MARCENE
Other - Last Name:KNUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-892-6401
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:729 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3340
Practice Address - Country:US
Practice Address - Phone:303-697-2583
Practice Address - Fax:970-867-2511
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1636119163W00000X
COAPN.0995931.NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse