Healthcare Provider Details

I. General information

NPI: 1801971767
Provider Name (Legal Business Name): JEAN KENNEDY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 S 32ND ST
PHOENIX AZ
85048-7807
US

IV. Provider business mailing address

16440 S 32ND ST
PHOENIX AZ
85048-7807
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-7936
  • Fax: 480-706-7976
Mailing address:
  • Phone: 480-706-7936
  • Fax: 480-706-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: