Healthcare Provider Details

I. General information

NPI: 1043021629
Provider Name (Legal Business Name): JENNIFER KENNEDY APRN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 02/27/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S DOUGLAS BLVD
MIDWEST CITY OK
73130-6224
US

IV. Provider business mailing address

1800 S DOUGLAS BLVD
MIDWEST CITY OK
73130-6224
US

V. Phone/Fax

Practice location:
  • Phone: 405-741-7722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR0131654
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number221867
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: