Provider Demographics
NPI:1336959014
Name:FUNCHES, KENISHA TEREE (LPN)
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:TEREE
Last Name:FUNCHES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FIVE IRON CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5065
Mailing Address - Country:US
Mailing Address - Phone:405-436-5436
Mailing Address - Fax:
Practice Address - Street 1:200 FIVE IRON CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5065
Practice Address - Country:US
Practice Address - Phone:405-436-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN093821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse