MEDICARE: MRS. MARTHA KILKENNY F.N.P, R.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN258149	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ15652Z	OTHER	CA	PIN #

General Provider Information

NPI Number	:	1245224997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA KILKENNY F.N.P, R.N

Provider Business Mailing Address
First Line	:	PO BOX 3067
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95992-3067
Country	:	US
Telephone Number	:	530-751-4784
Fax Number	:	530-751-4906

Provider Business Practice Location Address
First Line	:	370 DEL NORTE AVE STE 201
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4142
Country	:	US
Telephone Number	:	530-821-2020
Fax Number	:	530-751-2704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/10/2019

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