Healthcare Provider Details

I. General information

NPI: 1134703630
Provider Name (Legal Business Name): KYLIE NICHOLE KENNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 CHANTICLEER AVE
SANTA CRUZ CA
95065-1815
US

IV. Provider business mailing address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-2375
  • Fax:
Mailing address:
  • Phone: 585-922-4683
  • Fax: 585-922-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA207035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: