Provider Demographics
NPI:1922673979
Name:GARTH, KENYETTA (MA, CLD)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:
Last Name:GARTH
Suffix:
Gender:F
Credentials:MA, CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SAMUEL ST APT 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1556
Mailing Address - Country:US
Mailing Address - Phone:314-680-9198
Mailing Address - Fax:
Practice Address - Street 1:1445 SAMUEL ST APT 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1556
Practice Address - Country:US
Practice Address - Phone:314-680-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula