Provider Demographics
NPI:1437854627
Name:KENNEY, GRACE OPOKU
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:OPOKU
Last Name:KENNEY
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:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER
Mailing Address - Street 2:11937 U.S. HWY. 271
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708
Mailing Address - Country:US
Mailing Address - Phone:903-877-7200
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER
Practice Address - Street 2:11937 U.S. HWY. 271
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708
Practice Address - Country:US
Practice Address - Phone:903-877-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10085252390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program