Healthcare Provider Details

I. General information

NPI: 1689044026
Provider Name (Legal Business Name): SHELLY K KENNEDY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S EMERSON AVE
WENATCHEE WA
98801-2612
US

IV. Provider business mailing address

141 S EMERSON AVE
WENATCHEE WA
98801-2612
US

V. Phone/Fax

Practice location:
  • Phone: 504-452-5252
  • Fax:
Mailing address:
  • Phone: 504-452-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10019618
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08549
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN126476
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.60686679-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: