Healthcare Provider Details

I. General information

NPI: 1255665220
Provider Name (Legal Business Name): EMILEE KENNEDY ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 M 119
HARBOR SPRINGS MI
49740
US

IV. Provider business mailing address

8881 M 119
HARBOR SPRINGS MI
49740-9586
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5400
  • Fax: 231-348-2515
Mailing address:
  • Phone: 231-347-5400
  • Fax: 231-348-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704231427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: