Provider Demographics
NPI:1194851246
Name:KENYON, TERRY BOYLE (CRNP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:BOYLE
Last Name:KENYON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 DOVES FLY WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1248
Mailing Address - Country:US
Mailing Address - Phone:401-396-9472
Mailing Address - Fax:
Practice Address - Street 1:210 GUILFORD AVE
Practice Address - Street 2:2ND FLOOR, SBHC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3621
Practice Address - Country:US
Practice Address - Phone:410-396-8615
Practice Address - Fax:410-545-6636
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109107363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics