Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 729 | NE |
NPI | 1174772594 |
---|---|
Provider Name | Dr. Diana Kenyon |
First Address | Fort Campbell, KY 42223 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 13/09/2012 |