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General NPI Number Information
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NPI Number | 1194851246
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Entity Type | Individual
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Provider Name | TERRY BOYLE KENYON CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 210 GUILFORD AVE 2ND FLOOR, SBHC
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City | BALTIMORE
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State | MD
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Zip | 21202-3621
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Country | US
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Telephone | 410-396-8615
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Fax | 410-545-6636
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Provider Business Mailing Address
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Address Line | 8660 DOVES FLY WAY
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City | LAUREL
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State | MD
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Zip | 20723-1248
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Country | US
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Telephone | 401-396-9472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R109107
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License Number State | MD
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