Individual
SHELBY N KENISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
28675 740TH AVE, CLARKS GROVE, MN 56016-4041
(507) 213-3487
Mailing address
28675 740TH AVE, CLARKS GROVE, MN 56016-4041
(507) 213-3487
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2306
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790020949
NPI
MN
Enumeration date
11/29/2012
Last updated
03/11/2020
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