MEDICARE: BARBARA JEAN KENNEY APN

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	041209065	IL

General Provider Information

NPI Number	:	1306234554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JEAN KENNEY APN

Provider Business Mailing Address
First Line	:	3203 W 85TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3726
Country	:	US
Telephone Number	:	773-737-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 W 85TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3726
Country	:	US
Telephone Number	:	773-737-9242
Fax Number	:

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

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	12/22/2014

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