Individual
SHELBY A. KENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5717 S ANTHONY BLVD, SUITE 100, FORT WAYNE, IN 46806-3386
(260) 469-3984
(260) 441-3375
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 458-3210
(260) 458-3211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061016A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000519082
BLUE CROSS BLUE SHIELD
—
05
—
200531880
—
IN
01
—
P00405718
RAILROAD MEDICARE
IN
Enumeration date
08/11/2006
Last updated
08/15/2022
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