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NPI Code Detail

MEDICARE: MRS. JENNIFER WING KENNEDY CPNP

MEDICARE: MRS. JENNIFER WING KENNEDY CPNP
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
1163W00000XRegistered NurseRN193467GA
2363L00000XNurse PractitionerAPRN-NP193467GA

General Provider Information

NPI Number : 1649455718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER WING KENNEDY CPNP
Provider Business Mailing Address
First Line : 403 S CANDLER ST
Second Line :
City : DECATUR
State : GA
Zip : 30030-3748
Country : US
Telephone Number : 207-831-9127
Fax Number :
Provider Business Practice Location Address
First Line : 1875 CENTURY BLVD NE STE 150
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3323
Country : US
Telephone Number : 404-633-4595
Fax Number : 404-633-6637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2008
Last Update Date : 12/09/2025

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