Provider Demographics
NPI:1609635754
Name:POISSON, KEPHA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KEPHA
Middle Name:
Last Name:POISSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MADISON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6825
Mailing Address - Country:US
Mailing Address - Phone:781-462-7012
Mailing Address - Fax:
Practice Address - Street 1:120 MADISON ST APT 2
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6825
Practice Address - Country:US
Practice Address - Phone:781-462-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN101808164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse