Individual
KENYON CHRISTOPHER CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3921 W BASELINE RD, LAVEEN, AZ 85339-1801
(605) 764-4036
Mailing address
14300 W BELL RD UNIT 429, SURPRISE, AZ 85374-9735
(480) 652-9723
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN232862
AZ
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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