Provider Demographics
NPI:1265203715
Name:THOMAS, KENYETTA L (LPN)
Entity type:Individual
Prefix:
First Name:KENYETTA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KENYETTA
Other - Middle Name:L
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 SNOW ST STE E
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-5400
Mailing Address - Country:US
Mailing Address - Phone:470-880-1953
Mailing Address - Fax:
Practice Address - Street 1:318 SNOW ST STE E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-5400
Practice Address - Country:US
Practice Address - Phone:470-880-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-061539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse