Healthcare Provider Details

I. General information

NPI: 1871218016
Provider Name (Legal Business Name): KENIKO L'SHAY ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4385
US

IV. Provider business mailing address

PO BOX 1350
KENLY NC
27542-1350
US

V. Phone/Fax

Practice location:
  • Phone: 919-300-4315
  • Fax:
Mailing address:
  • Phone: 252-813-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: