MEDICARE: TANYA KENSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1770129165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA KENSLEY

Provider Business Mailing Address
First Line	:	1501 S LEMAY AVE STE 205
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4253
Country	:	US
Telephone Number	:	970-233-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 S LEMAY AVE STE 205
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4253
Country	:	US
Telephone Number	:	970-233-8787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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Directions to “ TANYA KENSLEY ” Practice Location

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