Healthcare Provider Details

I. General information

NPI: 1710488010
Provider Name (Legal Business Name): KENNISHA LONDREA CHARLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 FM 1960 RD E STE 210
HUMBLE TX
77346-1831
US

IV. Provider business mailing address

4403 KENYA MANOR DR
HUMBLE TX
77396-4317
US

V. Phone/Fax

Practice location:
  • Phone: 832-818-5964
  • Fax: 844-605-1814
Mailing address:
  • Phone: 832-818-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1199281
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70534
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number1003992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: