Provider Demographics
NPI:1477361327
Name:TOLBERT, KENYANI AISHA
Entity type:Individual
Prefix:
First Name:KENYANI
Middle Name:AISHA
Last Name:TOLBERT
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 1:1742 GRACE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2262
Mailing Address - Country:US
Mailing Address - Phone:404-974-6642
Mailing Address - Fax:
Practice Address - Street 1:521 1ST ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-1801
Practice Address - Country:US
Practice Address - Phone:404-972-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker