Healthcare Provider Details

I. General information

NPI: 1538760277
Provider Name (Legal Business Name): JENNIFER MICHELLE KENNEDY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONE OAK RD STE 124
PADUCAH KY
42001-4435
US

IV. Provider business mailing address

1029 MEDICAL CENTER CIR STE 202
MAYFIELD KY
42066-1189
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-7111
  • Fax: 812-476-7117
Mailing address:
  • Phone: 270-247-7795
  • Fax: 800-574-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015447
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: