Provider Demographics
NPI:1215623236
Name:GARNETT, KEILEN-JAMES
Entity type:Individual
Prefix:MR
First Name:KEILEN-JAMES
Middle Name:
Last Name:GARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 BRIAR FOREST DR APT 5192
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2466
Mailing Address - Country:US
Mailing Address - Phone:346-946-2348
Mailing Address - Fax:
Practice Address - Street 1:13202 BRIAR FOREST DR APT 5192
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2466
Practice Address - Country:US
Practice Address - Phone:346-946-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty