Provider Demographics
NPI:1487430153
Name:BYRD, MCKENNA ORDWAY (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:ORDWAY
Last Name:BYRD
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:ORDWAY
Other - Last Name:TRIMBATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11445 WILD FOX LN
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2114
Mailing Address - Country:US
Mailing Address - Phone:757-812-3679
Mailing Address - Fax:
Practice Address - Street 1:1213 E CLAY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5071
Practice Address - Country:US
Practice Address - Phone:800-726-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188062363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care