Provider Demographics
NPI:1801609805
Name:SIDES, KENESHA YVONNE
Entity type:Individual
Prefix:
First Name:KENESHA
Middle Name:YVONNE
Last Name:SIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KENESHA
Other - Middle Name:YVONNE
Other - Last Name:SIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4118 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3460
Mailing Address - Country:US
Mailing Address - Phone:531-772-2959
Mailing Address - Fax:
Practice Address - Street 1:4118 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3460
Practice Address - Country:US
Practice Address - Phone:531-772-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant