Provider Demographics
NPI:1588261432
Name:DUNCAN, KENZIE LEA
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:LEA
Last Name:DUNCAN
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:GLEN FERRIS
Mailing Address - State:WV
Mailing Address - Zip Code:25090-0046
Mailing Address - Country:US
Mailing Address - Phone:304-663-6089
Mailing Address - Fax:
Practice Address - Street 1:84 FERRIS DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN FERRIS
Practice Address - State:WV
Practice Address - Zip Code:25090
Practice Address - Country:US
Practice Address - Phone:304-663-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant