Individual
KENISHA SHAWNTA PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0417
Mailing address
ATTN: MCXP-DQS-CR, 4430 MISSOURI AVENUE, BOX 1267, FORT LEONARD WOOD, MO 65473
(573) 596-0417
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME117245
FL
Other
Enumeration date
06/08/2012
Last updated
06/14/2022
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