Healthcare Provider Details

I. General information

NPI: 1982398897
Provider Name (Legal Business Name): JENNIFER KENNERK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD KELLEY AVE
ORONO ME
04473-3402
US

IV. Provider business mailing address

15 OLD KELLEY AVE
ORONO ME
04473-3402
US

V. Phone/Fax

Practice location:
  • Phone: 207-802-7732
  • Fax: 207-348-8745
Mailing address:
  • Phone: 207-802-7732
  • Fax: 207-348-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP231234
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: