Provider Demographics
NPI:1811709694
Name:GOLDER, KENLEIGH
Entity type:Individual
Prefix:
First Name:KENLEIGH
Middle Name:
Last Name:GOLDER
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 1:1115 UPPER REACH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2664
Mailing Address - Country:US
Mailing Address - Phone:910-612-0999
Mailing Address - Fax:
Practice Address - Street 1:1115 UPPER REACH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2664
Practice Address - Country:US
Practice Address - Phone:910-612-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program