Healthcare Provider Details

I. General information

NPI: 1225477607
Provider Name (Legal Business Name): JESSICA KENNARD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 786
ORLANDO FL
32804-4651
US

IV. Provider business mailing address

900 WINDERLEY PL
MAITLAND FL
32751-7267
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2422
  • Fax: 407-303-2435
Mailing address:
  • Phone: 407-303-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberOS14414
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS14414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: