Healthcare Provider Details

I. General information

NPI: 1912562562
Provider Name (Legal Business Name): JAIMEE KENNEDY AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 04/22/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N BEERS ST
HOLMDEL NJ
07733-1514
US

IV. Provider business mailing address

727 N BEERS ST
HOLMDEL NJ
07733-1514
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-5900
  • Fax:
Mailing address:
  • Phone: 732-739-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00919700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00919700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: