Healthcare Provider Details

I. General information

NPI: 1003332396
Provider Name (Legal Business Name): JESSICA ANN KENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WESTOVER HILLS BLVD STE 108
SAN ANTONIO TX
78251-4842
US

IV. Provider business mailing address

5700 SCHERTZ PKWY STE 150
SCHERTZ TX
78154-1497
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax: 210-265-1442
Mailing address:
  • Phone: 210-366-3700
  • Fax: 210-265-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105858
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: