Provider Demographics
NPI:1851130496
Name:WASHINGTON, KENYENNA I
Entity type:Individual
Prefix:
First Name:KENYENNA
Middle Name:I
Last Name:WASHINGTON
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 1:370 COMMANDER CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-5957
Mailing Address - Country:US
Mailing Address - Phone:803-566-5003
Mailing Address - Fax:
Practice Address - Street 1:370 COMMANDER CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-5957
Practice Address - Country:US
Practice Address - Phone:803-840-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10089911376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide