Healthcare Provider Details

I. General information

NPI: 1649069501
Provider Name (Legal Business Name): JOSHUA TIMOTHY KENNY CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 1ST NORTH ST
MORRISTOWN TN
37814-4544
US

IV. Provider business mailing address

622 W 1ST NORTH ST
MORRISTOWN TN
37814-4544
US

V. Phone/Fax

Practice location:
  • Phone: 423-307-1890
  • Fax: 423-307-1891
Mailing address:
  • Phone: 423-307-1890
  • Fax: 423-307-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT00000000304
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPRO00000000296
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: