Provider Demographics
NPI:1356107783
Name:SAMPSON, KENOSHA DESHANE (RN)
Entity type:Individual
Prefix:
First Name:KENOSHA
Middle Name:DESHANE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-2055
Mailing Address - Country:US
Mailing Address - Phone:504-296-2181
Mailing Address - Fax:
Practice Address - Street 1:34 DIAMOND RD
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:LA
Practice Address - Zip Code:70079-2055
Practice Address - Country:US
Practice Address - Phone:504-296-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility