Provider Demographics
NPI:1154366797
Name:KENYON, CAROLYN JOYCE (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOYCE
Last Name:KENYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 URSULINES AVE
Mailing Address - Street 2:APT. REAR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-2421
Mailing Address - Country:US
Mailing Address - Phone:504-566-1766
Mailing Address - Fax:
Practice Address - Street 1:825 URSULINES AVE
Practice Address - Street 2:APT. REAR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-2421
Practice Address - Country:US
Practice Address - Phone:504-566-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08775R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE33648Medicare UPIN