Basic Information
| Provider Information | |||||||||
| NPI: | 1790394534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEY | ||||||||
| FirstName: | MARKISHA | ||||||||
| MiddleName: | KIAHNNA | ||||||||
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| Credential: | PSS, CHW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3612 W 18TH AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974022928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417311343 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 195 W 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417624319 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2020 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.