Healthcare Provider Details

I. General information

NPI: 1831589043
Provider Name (Legal Business Name): JANICE KENNEY JESSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANICE LOUISE KENNEY

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WEXLEIGH DR
RICHMOND VA
23229-7649
US

IV. Provider business mailing address

207 WEXLEIGH DR
RICHMOND VA
23229-7649
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-6685
  • Fax:
Mailing address:
  • Phone: 804-741-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101050071
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number059250
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number200501949
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD74937
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number0101050071
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberD74937
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number059250
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number200501949
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: