Healthcare Provider Details

I. General information

NPI: 1164330783
Provider Name (Legal Business Name): JOSEPH BRIAN KENNEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CAVENDISH DR
AMBLER PA
19002-4964
US

IV. Provider business mailing address

68 CAVENDISH DR
AMBLER PA
19002-4964
US

V. Phone/Fax

Practice location:
  • Phone: 215-870-3284
  • Fax:
Mailing address:
  • Phone: 215-870-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP037020
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: