Provider Demographics
NPI:1225670268
Name:ABNER, KYSHA (RN)
Entity Type:Individual
Prefix:
First Name:KYSHA
Middle Name:
Last Name:ABNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-0123
Mailing Address - Country:US
Mailing Address - Phone:909-277-7416
Mailing Address - Fax:
Practice Address - Street 1:1910 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-0123
Practice Address - Country:US
Practice Address - Phone:909-277-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598111163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health