Provider Demographics
NPI:1801518824
Name:KENLEA ALLURE LLC
Entity type:Organization
Organization Name:KENLEA ALLURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-551-1219
Mailing Address - Street 1:6421 N FLORIDA AVE # D-593
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6007
Mailing Address - Country:US
Mailing Address - Phone:813-551-1219
Mailing Address - Fax:813-923-3319
Practice Address - Street 1:11216 CARRICK STONE ST
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6321
Practice Address - Country:US
Practice Address - Phone:813-551-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier