Healthcare Provider Details

I. General information

NPI: 1932558327
Provider Name (Legal Business Name): ANNE MARIE KENNEDY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD STE 1K47
OFFUTT AFB NE
68113-1045
US

IV. Provider business mailing address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8600
  • Fax:
Mailing address:
  • Phone: 402-294-2056
  • Fax: 402-232-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1750
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: