Healthcare Provider Details

I. General information

NPI: 1316566375
Provider Name (Legal Business Name): CATHERINE F KENNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PROVIDENCE RD
WALLINGFORD PA
19086-6333
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone: 800-427-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2019046696
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: