DR. KENYETTA NICOLE NESBITT (NPI# 1073715397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073715397 |
| Entity Type | Individual |
| Full Name | DR. KENYETTA NICOLE NESBITT |
| Credential | PHARM.D. |
| Practice Address |
259 Mack Ave Eacphs Suite 2190 Detroit MI 48201-2427 |
| Mailing Address |
1301 Columbia Dr Flint MI 48503-5232 |
| Practice Telephone | 3139937465 |
| Mailing Telephone | 8102325328 |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
5302033279 | MI | Pharmacy Service Providers |
| Street Address |
259 MACK AVE EACPHS SUITE 2190 |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124642657 | Brenna Claire Stesney | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2020-06-01 |
| 1679195176 | Shane Michael Dignan | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2020-05-07 |
| 1871144766 | Janelle Yousif | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2019-09-23 |
| 1336701556 | Juela Kuci | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2019-07-08 |
| 1538726419 | Craig Keinath | Physician Assistant | 259 Mack Ave, Detroit, MI 48201-2427 | 2019-05-25 |
| 1194382077 | Kirk Bennett | Physician Assistant | 259 Mack Ave, Detroit, MI 48201 | 2019-05-25 |
| 1972902443 | Amber Lanae Smith | Pharmacist | 259 Mack Ave, Detroit, MI 48201-2427 | 2014-08-20 |
| 1659787182 | Kristina Nada Dabish | Physician Assistant | 259 Mack Ave, 2590, Detroit, MI 48201-2427 | 2014-07-03 |
| 1205180049 | Paul Evan Kilgore | Internal Medicine | 259 Mack Ave, Suite 2118, Detroit, MI 48201-2427 | 2012-11-01 |
| 1962777110 | Matthew Joseph Hynes | Veterinarian | 259 Mack Ave, Claws & Paws Clinic Wsu/dlar-wcccd/lvt, Detroit, MI 48201-2427 | 2012-03-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
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| Taxonomy Code | 1835P1200X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacotherapy |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619122157 | Dennis Veal | Pharmacist | 7900 Kercheval, Detroit, MI 48214-2968 | 2008-11-25 |
| 1124168513 | Sav Mart Pharmacy | Pharmacist | 7011 Gratiot Ave, Sav-mart Pharmacy, Detroit, MI 48207-1973 | 2007-02-07 |
| 1821192287 | Carole S Adams | Pharmacist | John R St, John D Dingell Va Pharmacy Dept 118 Cp, Detroit, MI 48201 | 2006-09-07 |
| 1508977885 | Matthew Thomas Mroozian | Pharmacist | 4646 John R St # 118-cp, Detroit, MI 48201-1916 | 2006-08-31 |
| 1619959707 | Candice Garwood | Pharmacist | 3990 John R St, Department of Pharmacy, Detroit, MI 48201-2018 | 2005-11-15 |
| 1093369001 | Tony Tayar | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2019-07-29 |
| 1295283778 | Justin R Super | Pharmacist | 21431 Grand River Ave, Detroit, MI 48219-3801 | 2016-09-14 |
| 1023401411 | Jodi Lecuyer | Pharmacist | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2015-03-10 |
| 1992130504 | Nimisha Sulejmani | Pharmacist | 2799 W Grand Blvd, Pharmacy Administration, Detroit, MI 48202-2608 | 2013-09-13 |
| 1851731368 | Carol Lynn Moore | Pharmacist | 2799 W Grand Blvd, Cfp-519, Detroit, MI 48202-2608 | 2013-06-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.