Provider Demographics
NPI:1841275278
Name:GAYDEN, KENYA DAWN
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:DAWN
Last Name:GAYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:DAWN
Other - Last Name:ASBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31832-B 3RD PL SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023
Mailing Address - Country:US
Mailing Address - Phone:253-205-6302
Mailing Address - Fax:
Practice Address - Street 1:31832-B 3RD PL SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023
Practice Address - Country:US
Practice Address - Phone:253-205-6302
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00057749183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician