Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD0000051717 | TN |
N | 207NP0225X | Pediatric Dermatologist | MD0000051717 | TN |
N | 207NS0135X | Procedural Dermatology | MD000051717 | TN |
NPI | 1396065769 |
---|---|
Provider Name | Kemunto Mokaya |
First Address | Maryville, TN 37801-4703 |
Second Address | Alcoa, TN 37701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 14/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q010542 | (05) | TN |