Provider Demographics
NPI:1780257915
Name:KENNEH, WATTA MARTHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:WATTA
Middle Name:MARTHA
Last Name:KENNEH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WINDCASTLE DR APT 1323
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1053
Mailing Address - Country:US
Mailing Address - Phone:317-657-6787
Mailing Address - Fax:
Practice Address - Street 1:210 WINDCASTLE DR APT 1323
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1053
Practice Address - Country:US
Practice Address - Phone:317-657-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health