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General NPI Number Information
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NPI Number | 1033255765
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Entity Type | Individual
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Provider Name | JILL MARIE KENNEDY WHCNP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 5750 PINELAND DR., STE #240 SUITE 206
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City | DALLAS
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State | TX
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Zip | 75231-4534
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Country | US
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Telephone | 469-637-2777
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Fax | 469-637-2760
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Provider Business Mailing Address
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Address Line | 5750 PINELAND DR STE 240
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City | DALLAS
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State | TX
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Zip | 75231-5300
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Country | US
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Telephone | 469-637-2777
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Fax | 469-637-2760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP105620
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License Number State | TX
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