Provider Demographics
NPI:1790394534
Name:KENNEY, MARKISHA KIAHNNA (PSS, CHW)
Entity Type:Individual
Prefix:
First Name:MARKISHA
Middle Name:KIAHNNA
Last Name:KENNEY
Suffix:
Gender:F
Credentials:PSS, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 W 18TH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2928
Mailing Address - Country:US
Mailing Address - Phone:541-731-1343
Mailing Address - Fax:
Practice Address - Street 1:195 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3408
Practice Address - Country:US
Practice Address - Phone:541-762-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist