Provider Demographics
NPI:1154189892
Name:BASSEY, KENNIE
Entity type:Individual
Prefix:MS
First Name:KENNIE
Middle Name:
Last Name:BASSEY
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 1:20 ROBERT CT APT B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-7372
Mailing Address - Country:US
Mailing Address - Phone:603-716-0279
Mailing Address - Fax:
Practice Address - Street 1:29 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4068
Practice Address - Country:US
Practice Address - Phone:603-577-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH084656-21390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program