Provider Demographics
NPI:1770281420
Name:SENIOR, KHYDINE (APRN)
Entity type:Individual
Prefix:
First Name:KHYDINE
Middle Name:
Last Name:SENIOR
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 197515
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-7515
Mailing Address - Country:US
Mailing Address - Phone:941-782-4391
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:379 6TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8820
Practice Address - Country:US
Practice Address - Phone:941-782-4150
Practice Address - Fax:941-782-4104
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024330363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health