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General NPI Number Information
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NPI Number | 1336650282
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Entity Type | Individual
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Provider Name | BRICE KEVIN DEMMASSE KENFACK
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Gender | Male
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 820 UPSHUR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5837
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Country | US
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Telephone | 202-723-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 GEORGIA AVE NW STE 323
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City | WASHINGTON
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State | DC
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Zip | 20012-1616
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Country | US
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Telephone | 202-723-3060
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | HHA13074
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA13074
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License Number State | DC
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