Provider Demographics
NPI:1356552988
Name:KENNEY, TANYA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DELAWARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-1756
Mailing Address - Country:US
Mailing Address - Phone:760-267-6636
Mailing Address - Fax:
Practice Address - Street 1:3300 N RIDGE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3383
Practice Address - Country:US
Practice Address - Phone:410-750-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP34741164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse