Provider Demographics
NPI:1962054197
Name:KORNEGAY, TENNILLE RENEE
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:RENEE
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 TERRAPIN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5020
Mailing Address - Country:US
Mailing Address - Phone:301-281-1185
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 823
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4016
Practice Address - Country:US
Practice Address - Phone:202-390-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide