Healthcare Provider Details
I. General information
NPI: 1699376996
Provider Name (Legal Business Name): LAUREN KENNERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/03/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
PO BOX 211699
EAGAN MN
55121-3699
US
IV. Provider business mailing address
PO BOX 211699
EAGAN MN
55121-3699
US
V. Phone/Fax
- Phone: 866-849-0692
- Fax: 888-973-8821
- Phone: 866-849-0692
- Fax: 888-973-8821
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 2026009163 |
| License Number State | MO |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | C-APN.0106154-C-NP |
| License Number State | CO |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | APRN11045621 |
| License Number State | FL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 041425398 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 3-002805 |
| License Number State | AL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 0028862 |
| License Number State | OH |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 31849 |
| License Number State | SC |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP2300X |
| Taxonomy | Primary Care Nurse Practitioner |
| License Number | 95017524 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 1231287 |
| License Number State | TX |
| # 10 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | APRN-NP335780 |
| License Number State | GA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | SP035463 |
| License Number State | PA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | H189520 |
| License Number State | IA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 908237 |
| License Number State | MS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
