Provider Demographics
NPI:1083447957
Name:SULLIVAN, KENISHA BEST (RN)
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:BEST
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS STE 215
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:980-777-0776
Mailing Address - Fax:
Practice Address - Street 1:4614 WILGROVE MINT HILL RD STE C3
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3547
Practice Address - Country:US
Practice Address - Phone:704-412-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229703163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator