Provider Demographics
NPI:1437841335
Name:CONER, KENYETTA RENEE
Entity Type:Individual
Prefix:MS
First Name:KENYETTA
Middle Name:RENEE
Last Name:CONER
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 1:7500 CALDERON CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2264
Mailing Address - Country:US
Mailing Address - Phone:703-203-2954
Mailing Address - Fax:
Practice Address - Street 1:7500 CALDERON CT UNIT A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2264
Practice Address - Country:US
Practice Address - Phone:703-203-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver