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General NPI Number Information
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NPI Number | 1366824963
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Entity Type | Individual
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Provider Name | MARY M KENYON CNP
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | CROSS HEART CARE 848 N 4TH ST.
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City | FORT SUMNER
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State | NM
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Zip | 88119
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Country | US
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Telephone | 575-355-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 928
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City | FORT SUMNER
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State | NM
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Zip | 88119-0928
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Country | US
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Telephone | 575-355-2273
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02696
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License Number State | NM
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