Provider Demographics
NPI:1457954141
Name:KENTY, WANDA FAYE
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:FAYE
Last Name:KENTY
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 1:1639 EASTBROOK DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3703
Mailing Address - Country:US
Mailing Address - Phone:614-274-8115
Mailing Address - Fax:
Practice Address - Street 1:1639 EASTBROOK DR S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3703
Practice Address - Country:US
Practice Address - Phone:614-274-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide