Healthcare Provider Details

I. General information

NPI: 1992069058
Provider Name (Legal Business Name): JENIFER L MCKENNEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENIFER M PIPER

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE STREET WEBBER WEST SUITE 141
BANGOR ME
04401
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4670
  • Fax: 207-973-4669
Mailing address:
  • Phone: 207-973-4670
  • Fax: 207-973-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNP121061
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121061
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: