Healthcare Provider Details

I. General information

NPI: 1831595552
Provider Name (Legal Business Name): TERRA KENNEDY MEAIRS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRA KENNEDY CNM

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

3312 W 38TH AVE
DENVER CO
80211-1910
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-9150
Mailing address:
  • Phone: 970-231-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0991474-CNM
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRXN.0101565-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: