Provider Demographics
NPI:1518584440
Name:THOMPSON, KENEISHA S (RN)
Entity Type:Individual
Prefix:
First Name:KENEISHA
Middle Name:S
Last Name:THOMPSON
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 1:8426 MANASSAS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6362
Mailing Address - Country:US
Mailing Address - Phone:713-481-8857
Mailing Address - Fax:
Practice Address - Street 1:8426 MANASSAS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6362
Practice Address - Country:US
Practice Address - Phone:832-498-7491
Practice Address - Fax:713-481-8430
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX843523163WM0705X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4143638Medicaid