Provider Demographics
NPI:1124331293
Name:KENAN, KIMBERLY LYNNE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:KENAN
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 1:760 N MCCRARY ST
Mailing Address - Street 2:APT A
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-4352
Mailing Address - Country:US
Mailing Address - Phone:336-302-4448
Mailing Address - Fax:
Practice Address - Street 1:760 N MCCRARY ST
Practice Address - Street 2:APT A
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-4352
Practice Address - Country:US
Practice Address - Phone:336-302-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist