Provider Demographics
NPI:1437553328
Name:BROWN, KENYA NICKITA (CRT)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:NICKITA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4764
Mailing Address - Country:US
Mailing Address - Phone:267-595-0080
Mailing Address - Fax:
Practice Address - Street 1:630 5TH AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4764
Practice Address - Country:US
Practice Address - Phone:267-595-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYM0147462278S1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute Care