Healthcare Provider Details

I. General information

NPI: 1588207658
Provider Name (Legal Business Name): BILLIE KENNEDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST STE 305
MARIETTA OH
45750-1600
US

IV. Provider business mailing address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-5662
  • Fax: 740-568-5672
Mailing address:
  • Phone: 505-724-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58141
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0026979
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: