Provider Demographics
NPI:1336959238
Name:KENYON, PRISCILLA LYNN (BSN, RN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LYNN
Last Name:KENYON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PLUM DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8463
Mailing Address - Country:US
Mailing Address - Phone:817-992-5408
Mailing Address - Fax:
Practice Address - Street 1:1575 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4901
Practice Address - Country:US
Practice Address - Phone:817-702-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX788619163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency