Provider Demographics
NPI:1083163984
Name:KEARBY, FEONIA FARRAH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:FEONIA
Middle Name:FARRAH
Last Name:KEARBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:FEONIA
Other - Middle Name:FARRAH
Other - Last Name:FERRIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:1801 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2186
Mailing Address - Country:US
Mailing Address - Phone:414-288-6790
Mailing Address - Fax:
Practice Address - Street 1:111 SPRINGHALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5351
Practice Address - Country:US
Practice Address - Phone:866-773-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020015474124Q00000X
WI1002971-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390806251Medicaid
WI390806251OtherFORWARD HEALT
WI390806251Medicare Oscar/Certification
WI390806251Medicare UPIN
WI390806251OtherFORWARD HEALT