Provider Demographics
NPI:1871927947
Name:HENRY, KENIESHA LATOYA (LPN)
Entity type:Individual
Prefix:MISS
First Name:KENIESHA
Middle Name:LATOYA
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1427
Mailing Address - Country:US
Mailing Address - Phone:845-871-1057
Mailing Address - Fax:845-876-0713
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1427
Practice Address - Country:US
Practice Address - Phone:845-871-1057
Practice Address - Fax:845-876-0713
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse