Healthcare Provider Details

I. General information

NPI: 1871052944
Provider Name (Legal Business Name): KENYA PRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/13/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N WATER ST
MILWAUKEE WI
53202-2557
US

IV. Provider business mailing address

1433 N WATER ST
MILWAUKEE WI
53202-2557
US

V. Phone/Fax

Practice location:
  • Phone: 262-230-5190
  • Fax:
Mailing address:
  • Phone: 262-230-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberP6305138483609
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: