Provider Demographics
NPI:1770199523
Name:COWAINS, KENYATTA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENYATTA
Middle Name:
Last Name:COWAINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 GOODMAN RD APT 3704
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1979
Mailing Address - Country:US
Mailing Address - Phone:662-820-5769
Mailing Address - Fax:
Practice Address - Street 1:9400 GOODMAN RD APT 3704
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1979
Practice Address - Country:US
Practice Address - Phone:662-820-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCOWA-NINHNZ363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily