Healthcare Provider Details

I. General information

NPI: 1265358808
Provider Name (Legal Business Name): KENYATTA ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 DANIEL ST
TARBORO NC
27886-2294
US

IV. Provider business mailing address

826 DANIEL ST
TARBORO NC
27886-2294
US

V. Phone/Fax

Practice location:
  • Phone: 252-452-5192
  • Fax:
Mailing address:
  • Phone: 252-452-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: