Provider Demographics
NPI:1427484179
Name:SHEARS, KENYACTHA
Entity type:Individual
Prefix:
First Name:KENYACTHA
Middle Name:
Last Name:SHEARS
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 1:2204 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2249
Mailing Address - Country:US
Mailing Address - Phone:504-701-9594
Mailing Address - Fax:
Practice Address - Street 1:2204 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2249
Practice Address - Country:US
Practice Address - Phone:504-701-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)