Healthcare Provider Details

I. General information

NPI: 1346243094
Provider Name (Legal Business Name): ROBERT J KENNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2005
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 ODONOVAN DR FL 1
BATON ROUGE LA
70808-4782
US

IV. Provider business mailing address

5131 ODONOVAN DR FL 1
BATON ROUGE LA
70808-4782
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-4893
  • Fax: 225-408-1959
Mailing address:
  • Phone: 225-767-4893
  • Fax: 225-408-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number015800
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: