Provider Demographics
NPI:1073003984
Name:KEBEDE, TEGEST
Entity type:Individual
Prefix:
First Name:TEGEST
Middle Name:
Last Name:KEBEDE
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 1:3925 BLACKBURN LN APT 21
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1266
Mailing Address - Country:US
Mailing Address - Phone:240-413-0345
Mailing Address - Fax:
Practice Address - Street 1:3925 BLACKBURN LN APT 21
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1266
Practice Address - Country:US
Practice Address - Phone:240-413-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13078374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide