Provider Demographics
NPI:1215418611
Name:COORE, KENESHA LATOYA
Entity Type:Individual
Prefix:
First Name:KENESHA
Middle Name:LATOYA
Last Name:COORE
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 1:1118 BLUE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6252
Mailing Address - Country:US
Mailing Address - Phone:832-692-3857
Mailing Address - Fax:
Practice Address - Street 1:1118 BLUE LEAF DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6252
Practice Address - Country:US
Practice Address - Phone:832-692-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse