Provider Demographics
NPI:1528752136
Name:MATTOCKS, KE'NESHA SOPHIA NICOLE
Entity type:Individual
Prefix:MS
First Name:KE'NESHA
Middle Name:SOPHIA NICOLE
Last Name:MATTOCKS
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 1:3401 GOVERNMENT STREET
Mailing Address - Street 2:#6871
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-6871
Mailing Address - Country:US
Mailing Address - Phone:318-451-2282
Mailing Address - Fax:
Practice Address - Street 1:1366 AUTUMN ORCHARD LOOP
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-5070
Practice Address - Country:US
Practice Address - Phone:318-451-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach