Provider Demographics
NPI:1952799371
Name:KENYON, DIANA L (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:KENYON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1234
Mailing Address - Country:US
Mailing Address - Phone:334-283-3111
Mailing Address - Fax:
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1234
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily