Provider Demographics
NPI:1457170797
Name:MCLEMORE, KEZIA TYREE ANDRENETTE (RN)
Entity type:Individual
Prefix:
First Name:KEZIA
Middle Name:TYREE ANDRENETTE
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 E 53RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3627
Mailing Address - Country:US
Mailing Address - Phone:877-523-6160
Mailing Address - Fax:
Practice Address - Street 1:4620 E 53RD ST STE 200
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3627
Practice Address - Country:US
Practice Address - Phone:877-523-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA177268163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical