Healthcare Provider Details

I. General information

NPI: 1386370856
Provider Name (Legal Business Name): KATHLEEN BRIDGET KENNA FNP-C, MSN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3477
US

IV. Provider business mailing address

400 E MAIN ST
MOUNT KISCO NY
10549-3477
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1200
  • Fax:
Mailing address:
  • Phone: 914-666-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: