Healthcare Provider Details

I. General information

NPI: 1235499914
Provider Name (Legal Business Name): ADRIA MARIE KENNEDY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ROUTE 28
HARWICH PORT MA
02646-1931
US

IV. Provider business mailing address

PO BOX 2796
ORLEANS MA
02653-6796
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-1400
  • Fax: 508-487-6298
Mailing address:
  • Phone: 508-432-1400
  • Fax: 508-487-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN227719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: