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NPI Code Detail

MEDICARE: SHENISE KEMP

MEDICARE: SHENISE KEMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-180184FL

General Provider Information

NPI Number : 1245981620
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHENISE KEMP
Provider Business Mailing Address
First Line : PO BOX 253
Second Line :
City : SKILLMAN
State : NJ
Zip : 08558-0253
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10175 FORTUNE PKWY UNIT 802
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6754
Country : US
Telephone Number : 904-895-5865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2022
Last Update Date : 01/17/2022

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