Provider Demographics
NPI:1184198020
Name:WARNOCK, KRESHA
Entity Type:Individual
Prefix:
First Name:KRESHA
Middle Name:
Last Name:WARNOCK
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 1:2365 N MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-9289
Mailing Address - Country:US
Mailing Address - Phone:765-661-9856
Mailing Address - Fax:
Practice Address - Street 1:2365 N MILLER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-9289
Practice Address - Country:US
Practice Address - Phone:765-661-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist