MEDICARE: MS. KECIANA LIND ENAOHWO MS. MA. CHW, CHWI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	4947	TX

General Provider Information

NPI Number	:	1700693140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KECIANA LIND ENAOHWO MS. MA. CHW, CHWI

Provider Business Mailing Address
First Line	:	1803 VILLA DEL LAGO DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4633
Country	:	US
Telephone Number	:	281-650-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 VILLA DEL LAGO DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4633
Country	:	US
Telephone Number	:	281-650-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	07/22/2025

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