MEDICARE: AMBER KENNEDY BSN, RN

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	163WN0002X	Neonatal Intensive Care Registered Nurse	28275372C	IN

General Provider Information

NPI Number	:	1548116106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER KENNEDY BSN, RN

Provider Business Mailing Address
First Line	:	5417 NEWLAND PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-3883
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-672-6400
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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