Provider Demographics
NPI:1588480057
Name:OUMA, KENNETH O (RN)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:O
Last Name:OUMA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 CHERRY BARK LOOP
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9522
Mailing Address - Country:US
Mailing Address - Phone:919-637-2440
Mailing Address - Fax:
Practice Address - Street 1:262 CHERRY BARK LOOP
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9522
Practice Address - Country:US
Practice Address - Phone:919-637-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC7525251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health