Healthcare Provider Details

I. General information

NPI: 1881678555
Provider Name (Legal Business Name): KENYON MCCUNE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENYON TEASLEY CRNA

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 CENTENNIAL BLVD SUITE 100
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

2633 CENTENNIAL BLVD STE 100
TALLAHASSEE FL
32308-0606
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5404
  • Fax: 850-431-4794
Mailing address:
  • Phone: 850-431-5404
  • Fax: 850-431-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2117432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: