Healthcare Provider Details

I. General information

NPI: 1851689905
Provider Name (Legal Business Name): JESSICA KENNEDY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SE TALLGRASS LN STE 250
WAUKEE IA
50263-6818
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-8300
  • Fax: 515-875-9202
Mailing address:
  • Phone: 515-875-9255
  • Fax: 515-875-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4401
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: