Healthcare Provider Details

I. General information

NPI: 1700180841
Provider Name (Legal Business Name): KENNEY C YODER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 EASTERN BYP SUITE 201
RICHMOND KY
40475-2422
US

IV. Provider business mailing address

PO BOX 34166
LEXINGTON KY
40588-4166
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-6560
  • Fax: 859-624-6569
Mailing address:
  • Phone: 859-624-6560
  • Fax: 859-624-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6766P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: