Healthcare Provider Details

I. General information

NPI: 1982696415
Provider Name (Legal Business Name): DR. JAMES A. KENNEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 12TH ST
MERIDIAN MS
39301-4158
US

IV. Provider business mailing address

1800 12TH ST
MERIDIAN MS
39301-4158
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-9928
  • Fax:
Mailing address:
  • Phone: 601-703-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF57233
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number15132
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: