Healthcare Provider Details

I. General information

NPI: 1619789500
Provider Name (Legal Business Name): KEVIN MICHAEL KENNEY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LIMBO LN
AMHERST NH
03031-1870
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-5885
  • Fax:
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number061430-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: