Healthcare Provider Details

I. General information

NPI: 1609574060
Provider Name (Legal Business Name): JULIE KENNEDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GRANT ST
THORNTON CO
80229-4329
US

IV. Provider business mailing address

6278 UNION ST
ARVADA CO
80004-4018
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-3690
  • Fax:
Mailing address:
  • Phone: 918-814-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0998357-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: