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General NPI Number Information
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NPI Number | 1316471527
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Entity Type | Individual
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Provider Name | KENISHA AKEILA NISBETT D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1513 S GRAND AVE STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90015-3075
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Country | US
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Telephone | 323-438-0483
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Fax | 310-862-6817
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Provider Business Mailing Address
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Address Line | 122 S GREEN ST STE 5
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City | TEHACHAPI
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State | CA
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Zip | 93561-1717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A17194
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 17194
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License Number State | CA
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