Provider Demographics
NPI:1649037110
Name:HADLEY, KENYON
Entity type:Individual
Prefix:
First Name:KENYON
Middle Name:
Last Name:HADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18207 N ELDRIDGE PKWY UNIT A5
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8169
Mailing Address - Country:US
Mailing Address - Phone:832-441-3700
Mailing Address - Fax:
Practice Address - Street 1:18207 N ELDRIDGE PKWY UNIT A5
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8169
Practice Address - Country:US
Practice Address - Phone:832-441-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health