Healthcare Provider Details

I. General information

NPI: 1932357639
Provider Name (Legal Business Name): MARSHA DAMARIS KENTISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BRANNON DR
VIRGINIA BEACH VA
23456-6908
US

IV. Provider business mailing address

2509 GEORGE MASON DR UNIT 6973
VIRGINIA BEACH VA
23456-1741
US

V. Phone/Fax

Practice location:
  • Phone: 757-404-6078
  • Fax:
Mailing address:
  • Phone: 757-404-6078
  • Fax: 757-282-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5574
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0001151757
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0001151757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: