Healthcare Provider Details

I. General information

NPI: 1174671267
Provider Name (Legal Business Name): CHRISTINE KENNY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 SW 27TH ST
PALM CITY FL
34990-2907
US

IV. Provider business mailing address

2058 NW ESTUARY CT
STUART FL
34994-8808
US

V. Phone/Fax

Practice location:
  • Phone: 772-255-6565
  • Fax:
Mailing address:
  • Phone: 917-575-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9535939
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11007630
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303770
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: