Detavia Kenan, CMA

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Practice address

2 Centerview Dr Ste 64
Greensboro, NC 27407-3708

Phone

(336) 303-0587

NPI assigned

Jul 26, 2024

Last updated

Jul 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Medical Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jack of All Stixx

  • Phlebotomy Technician
  • Greensboro, NC
  • NPI 1700611563
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1073342325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 WHISTLING SWAN DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274551535",
            "telephone_number": "919-696-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CENTERVIEW DR STE 64",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073708",
            "telephone_number": "336-303-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENAN",
        "first_name": "DETAVIA",
        "credential": "CMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Andrew Kelly, M.D. FACC
• Kelner Specialty Infusion Services, LLC (Vital Care of Greensboro)
• Shcaleah Kelton
• Brien Richard Kemmery, PHARM D
• Lauren Michelle Kemp, PHARMD
• Adam S Kendall, M.D.
• Lonnie Myron Kendall, NP
• Cheryl Denise Kendrick, PHARM.D.
• Kailei Margaret Michael Kendrick, LCMHCA
• Mari-Tate Kendrick, FNP

• Phlebotomy Technician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Phlebotomy Technician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.