Individual
SALLY BYRON KENYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1451 GEORGE WASHINGTON HWY, #245, GLOUCESTER POINT, VA 23062
(757) 706-4584
Mailing address
PO BOX 245, GLOUCESTER POINT, VA 23062-0245
(757) 706-4584
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002083205
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T64452265
DRIVERS LIC
KS
Enumeration date
06/13/2018
Last updated
06/07/2021
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