Healthcare Provider Details

I. General information

NPI: 1104842806
Provider Name (Legal Business Name): JANICE R KENNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 E THOMAS RD 100
SCOTTSDALE AZ
85251-5844
US

IV. Provider business mailing address

8111 E THOMAS RD 100
SCOTTSDALE AZ
85251-5844
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-0444
  • Fax: 602-952-7146
Mailing address:
  • Phone: 602-954-0444
  • Fax: 602-952-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP12
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: