Provider Demographics
NPI:1427514066
Name:STEPHENS, KENYATTA ANTOINETTE (MSN, RN)
Entity type:Individual
Prefix:
First Name:KENYATTA
Middle Name:ANTOINETTE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34369 RAMBLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4227
Mailing Address - Country:US
Mailing Address - Phone:248-396-5419
Mailing Address - Fax:
Practice Address - Street 1:34369 RAMBLE HILLS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-4227
Practice Address - Country:US
Practice Address - Phone:248-396-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190836163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent