Provider Demographics
NPI:1508852633
Name:KENYON, CHRISTI M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:M
Last Name:KENYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 NE 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2329
Mailing Address - Country:US
Mailing Address - Phone:206-617-1190
Mailing Address - Fax:
Practice Address - Street 1:3409 NE 57TH STREET
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-617-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023279207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5891740001OtherDME
WA49326OtherLABOR & INDUSTRY
WA8152415Medicaid
WAKE5443OtherREGENCE
WA660000764OtherPALMETTO RR MEDICARE
WA5891740001OtherDME
A06829Medicare UPIN