Provider Demographics
NPI:1336885722
Name:STARKS, KENISHA LATOYA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KENISHA
Middle Name:LATOYA
Last Name:STARKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 QUARRY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1026
Mailing Address - Country:US
Mailing Address - Phone:508-679-8111
Mailing Address - Fax:508-679-8116
Practice Address - Street 1:387 QUARRY ST STE 100
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1026
Practice Address - Country:US
Practice Address - Phone:508-679-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2309044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily