Provider Demographics
NPI:1003141003
Name:KENERLY, MINDI RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MINDI
Middle Name:RENEE
Last Name:KENERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 HONEYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1549
Mailing Address - Country:US
Mailing Address - Phone:937-829-9883
Mailing Address - Fax:
Practice Address - Street 1:3706 HONEYBROOK AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1549
Practice Address - Country:US
Practice Address - Phone:937-829-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 333332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse