Provider Demographics
NPI:1750901997
Name:BREWINGTON, KENITHIA Z
Entity type:Individual
Prefix:
First Name:KENITHIA
Middle Name:Z
Last Name:BREWINGTON
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 1:121 MILLET CIR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7888
Mailing Address - Country:US
Mailing Address - Phone:850-417-2281
Mailing Address - Fax:
Practice Address - Street 1:121 MILLET CIR
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-7888
Practice Address - Country:US
Practice Address - Phone:850-417-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100094512253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency