Provider Demographics
NPI:1174977946
Name:KENLEY, TANA L (PA-C)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:L
Last Name:KENLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28154 S 36TH RD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-5737
Mailing Address - Country:US
Mailing Address - Phone:402-806-5970
Mailing Address - Fax:
Practice Address - Street 1:3000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3319
Practice Address - Country:US
Practice Address - Phone:402-239-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant