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NPI Code Detail

MEDICARE: DR. BRYON MCKENNA D.P.M.

MEDICARE: DR. BRYON MCKENNA D.P.M.
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
1213ES0103XFoot & Ankle Surgery Podiatrist36.003919OH

General Provider Information

NPI Number : 1396108759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYON MCKENNA D.P.M.
Provider Business Mailing Address
First Line : 3323 S SNOWFLAKE WAY
Second Line :
City : BOISE
State : ID
Zip : 83706-5261
Country : US
Telephone Number : 208-860-2584
Fax Number :
Provider Business Practice Location Address
First Line : 290 BOWIE RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-6712
Country : US
Telephone Number : 985-493-4990
Fax Number : 985-493-4991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2016
Last Update Date : 02/10/2023

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