Healthcare Provider Details

I. General information

NPI: 1326540865
Provider Name (Legal Business Name): JMKENNEDY LLC MAGNUM NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6365 PLANKTON DR
COLUMBUS OH
43213
US

IV. Provider business mailing address

6365 PLANKTON DR
COLUMBUS OH
43213-3470
US

V. Phone/Fax

Practice location:
  • Phone: 614-561-5378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN317516
License Number StateOH

VIII. Authorized Official

Name: JULIE KENNEDY
Title or Position: CEO
Credential: NP
Phone: 614-986-7828