Healthcare Provider Details

I. General information

NPI: 1063645448
Provider Name (Legal Business Name): ANNA MARIE KENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE GAAL FNP

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BOHANNON DR STE 100
MENLO PARK CA
94025-1037
US

IV. Provider business mailing address

7693 WENSLEY LN
WESTERVILLE OH
43082-7189
US

V. Phone/Fax

Practice location:
  • Phone: 209-677-7468
  • Fax:
Mailing address:
  • Phone: 614-531-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number711370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number022229
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: