Provider Demographics
NPI:1164195418
Name:ALA, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:ALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 WOOD LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-7467
Mailing Address - Country:US
Mailing Address - Phone:912-432-5254
Mailing Address - Fax:
Practice Address - Street 1:1317 WOOD LAKE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-7467
Practice Address - Country:US
Practice Address - Phone:407-593-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X, 372500000X, 372600000X, 374U00000X
FL237380376J00000X
FL3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108873400Medicaid
FL237380OtherAHCA - HOMEMAKER COMPANION