Healthcare Provider Details

I. General information

NPI: 1548103310
Provider Name (Legal Business Name): SHYRHONDA KENEBREW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 JAMESTOWN ST UNIT J
LAKE CHARLES LA
70605-5711
US

IV. Provider business mailing address

3433 POLK ST
LAKE CHARLES LA
70607-2143
US

V. Phone/Fax

Practice location:
  • Phone: 337-508-2313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: