Healthcare Provider Details

I. General information

NPI: 1548026354
Provider Name (Legal Business Name): LORI SHARON KENNY APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 TROPICO DR
LA MESA CA
91941-6815
US

IV. Provider business mailing address

9430 TROPICO DR
LA MESA CA
91941-6815
US

V. Phone/Fax

Practice location:
  • Phone: 830-743-1832
  • Fax:
Mailing address:
  • Phone: 830-743-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1140496
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: