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General NPI Number Information
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NPI Number | 1407569817
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Entity Type | Individual
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Provider Name | KENNY CHRYSOSTOME
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Gender | Male
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 4810 RIVERSTONE BLVD STE 100
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City | MISSOURI CITY
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State | TX
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Zip | 77459-4092
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Country | US
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Telephone | 877-744-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 115 JAY CT
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1723
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Country | US
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Telephone | 561-797-9787
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP004147
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11042205
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License Number State | FL
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