Provider Demographics
NPI:1437641685
Name:MORTON, KENISHA MONIQUE
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:MONIQUE
Last Name:MORTON
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 1:17515 WOODFALLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2849
Mailing Address - Country:US
Mailing Address - Phone:832-405-4285
Mailing Address - Fax:
Practice Address - Street 1:17515 WOODFALLS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2849
Practice Address - Country:US
Practice Address - Phone:832-405-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX781557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse