Provider Demographics
NPI:1972003945
Name:GENT, KEYONDRA (LVN)
Entity Type:Individual
Prefix:
First Name:KEYONDRA
Middle Name:
Last Name:GENT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 LISMORE DR
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-4028
Mailing Address - Country:US
Mailing Address - Phone:469-254-3398
Mailing Address - Fax:
Practice Address - Street 1:2915 LISMORE DR
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-4028
Practice Address - Country:US
Practice Address - Phone:146-925-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306007164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse