Healthcare Provider Details

I. General information

NPI: 1861645384
Provider Name (Legal Business Name): ANNMARIE KENNY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

IV. Provider business mailing address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-9016
  • Fax: 716-626-4271
Mailing address:
  • Phone: 716-626-9016
  • Fax: 716-626-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF-401140-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: