Healthcare Provider Details

I. General information

NPI: 1043101777
Provider Name (Legal Business Name): KENNEDY PARHAM WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E GENESEE ST
SYRACUSE NY
13210-1994
US

IV. Provider business mailing address

114 UNIVERSITY AVE
ROCHESTER NY
14605-2992
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-6886
  • Fax: 315-475-5554
Mailing address:
  • Phone: 315-496-3824
  • Fax: 585-546-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number986991
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: