Provider Demographics
NPI:1023719358
Name:DAWKINS, KIPTENA
Entity type:Individual
Prefix:
First Name:KIPTENA
Middle Name:
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SANDY RIVER LN APT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4885
Mailing Address - Country:US
Mailing Address - Phone:864-641-5278
Mailing Address - Fax:
Practice Address - Street 1:5736 N TRYON ST STE 221C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-0820
Practice Address - Country:US
Practice Address - Phone:980-498-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6119253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care