Provider Demographics
NPI:1053300178
Name:SHORT, KENYA (MD)
Entity Type:Individual
Prefix:DR
First Name:KENYA
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KENYA
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3851 ROGER BROOKE DR.
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER, CAMP BULLIS USAHC
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-295-8074
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR.
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER, CAMP BULLIS USAHC
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-295-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054727A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine