Provider Demographics
NPI:1407343957
Name:AYENUMELO, LEKEYSHA
Entity Type:Individual
Prefix:
First Name:LEKEYSHA
Middle Name:
Last Name:AYENUMELO
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:PO BOX 2383
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-2383
Mailing Address - Country:US
Mailing Address - Phone:336-803-2908
Mailing Address - Fax:336-905-7311
Practice Address - Street 1:1408 HAMPSTEAD DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-4237
Practice Address - Country:US
Practice Address - Phone:336-803-2908
Practice Address - Fax:336-905-7311
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5013376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC5013OtherHOME CARE LICENSE NUMBER