Healthcare Provider Details

I. General information

NPI: 1316977903
Provider Name (Legal Business Name): SHARON D KENNEDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 NE GLISAN ST 3E
PORTLAND OR
97213-2933
US

IV. Provider business mailing address

PO BOX 4949
PORTLAND OR
97208-4949
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-6494
  • Fax: 503-215-6644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: