Individual provider Active NPI

Kennisha Londrea Charles, RN

  • Registered Nurse
  • Humble, TX
National Provider Identifier
1710488010
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
70534 Issued in TX
Practice address
8530 FM 1960 Rd E
Ste 210
Humble, TX 77346-1831
Phone
(832) 818-5964
Fax
(844) 605-1814
NPI assigned
Feb 22, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Other Specialist/Technologist 246Z00000X 1003992 TX
Family Nurse Practitioner 363LF0000X 1199281 TX
Registered Nurse 163W00000X 70534 TX Primary

Addresses

Primary practice location

8530 FM 1960 Rd E
Ste 210
Humble, TX 77346-1831

Mailing address

4403 Kenya Manor Dr
Humble, TX 77396-4317
Phone (832) 818-5964

Other practice location 1

720 Rollingbrook Dr
Baytown, TX 77521-4059
Phone (346) 787-1827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210319000583 TX Practitioner - Mass Immunization Roster Biller 4385051366 Practice locations: Humble, TX

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
70534TXMDRegistered Nurse
1003992TXMDOther Specialist/Technologist
1199281TXMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1710488010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 KENYA MANOR DR",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773964317",
            "telephone_number": "832-818-5964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8530 FM 1960 RD E",
            "address_2": "STE 210",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773461831",
            "telephone_number": "832-818-5964",
            "fax_number": "844-605-1814"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Rollingbrook Dr",
            "address_purpose": "LOCATION",
            "city": "Baytown",
            "state": "TX",
            "postal_code": "775214059",
            "country_code": "US",
            "telephone_number": "346-787-1827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "KENNISHA",
        "middle_name": "LONDREA",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "TX",
            "license": "1003992",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1199281",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "70534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Humble, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.