Healthcare Provider Details

I. General information

NPI: 1922848639
Provider Name (Legal Business Name): KENISHA EXUM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 S MEMORIAL DR
GREENVILLE NC
27834-2854
US

IV. Provider business mailing address

745 OLD SNOW HILL RD
AYDEN NC
28513-7712
US

V. Phone/Fax

Practice location:
  • Phone: 919-910-4001
  • Fax:
Mailing address:
  • Phone: 252-902-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number80926
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: