Healthcare Provider Details

I. General information

NPI: 1033747787
Provider Name (Legal Business Name): MRS. SHENAE MARCENE KEMBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHENAE MARCENE KNUDSON

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 E RAILROAD AVE
FORT MORGAN CO
80701-3340
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-2583
  • Fax: 970-867-2511
Mailing address:
  • Phone: 303-892-6401
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995931.NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1636119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: