Provider Demographics
NPI:1700180841
Name:YODER, KENNEY C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KENNEY
Middle Name:C
Last Name:YODER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34166
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-4166
Mailing Address - Country:US
Mailing Address - Phone:859-624-6560
Mailing Address - Fax:859-624-6569
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:859-624-6560
Practice Address - Fax:859-624-6569
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6766P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100149630Medicaid
KY7100149630Medicaid