Provider Demographics
NPI:1215698550
Name:GRIFFIN-EUGENE, KENYATTA
Entity type:Individual
Prefix:
First Name:KENYATTA
Middle Name:
Last Name:GRIFFIN-EUGENE
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 1:20715 S BLUE HYACINTH DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6699
Mailing Address - Country:US
Mailing Address - Phone:504-616-1086
Mailing Address - Fax:
Practice Address - Street 1:12238 QUEENSTON BLVD STE I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5351
Practice Address - Country:US
Practice Address - Phone:281-393-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX985860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse