Provider Demographics
NPI:1558179259
Name:TERRY, KENNITTA A
Entity type:Individual
Prefix:
First Name:KENNITTA
Middle Name:A
Last Name:TERRY
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 1:487 DEWDROP CIR APT F
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-5520
Mailing Address - Country:US
Mailing Address - Phone:513-546-7713
Mailing Address - Fax:
Practice Address - Street 1:487 DEWDROP CIR APT F
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-5520
Practice Address - Country:US
Practice Address - Phone:513-546-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child