Provider Demographics
NPI:1114815628
Name:FARRIS, KENZIE SHAY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:SHAY
Last Name:FARRIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 AVENUE C NW
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-4318
Mailing Address - Country:US
Mailing Address - Phone:940-585-8656
Mailing Address - Fax:
Practice Address - Street 1:901 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2320
Practice Address - Country:US
Practice Address - Phone:940-937-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1205035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily