=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588541932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN MARIE KENSEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12700 STAFFORD RD APT 1212 APT 1212
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-268-9883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12700 STAFFORD RD APT 1212 APT 1212
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-268-9883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number | 27120875
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------