Provider Demographics
NPI:1235787359
Name:DONOVAN, KENYA EARNESSA (KENYA)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:EARNESSA
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:KENYA
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:EARNESSA
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1087 WOODBURY CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-2660
Mailing Address - Country:US
Mailing Address - Phone:917-653-3425
Mailing Address - Fax:
Practice Address - Street 1:204 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1507
Practice Address - Country:US
Practice Address - Phone:917-653-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNAOtherNOT NEEDED