MEDICARE: LYDIA KENER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		UT

General Provider Information

NPI Number	:	1285224204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA KENER

Provider Business Mailing Address
First Line	:	417 SLATE DR
Second Line	:
City	:	SANTAQUIN
State	:	UT
Zip	:	84655-5707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 S 600 E STE A
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84606-4780
Country	:	US
Telephone Number	:	208-240-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2021
Last Update Date	:	01/23/2021

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Directions to “ LYDIA KENER ” Practice Location

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