Provider Demographics
NPI:1710488010
Name:CHARLES, KENNISHA LONDREA (RN)
Entity Type:Individual
Prefix:MS
First Name:KENNISHA
Middle Name:LONDREA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4403 KENYA MANOR DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4317
Mailing Address - Country:US
Mailing Address - Phone:832-818-5964
Mailing Address - Fax:
Practice Address - Street 1:8530 FM 1960 RD E
Practice Address - Street 2:STE 210
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1831
Practice Address - Country:US
Practice Address - Phone:832-818-5964
Practice Address - Fax:844-605-1814
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003992246Z00000X
TX70534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other