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General NPI Number Information
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NPI Number | 1043401672
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Entity Type | Individual
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Provider Name | KEVIN R KENERSON DO
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Gender | Male
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 174 S FREEPORT RD SUITE 2A
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City | FREEPORT
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State | ME
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Zip | 04032-6145
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Country | US
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Telephone | 855-239-3556
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Fax | 207-512-5909
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Provider Business Mailing Address
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Address Line | 174 S FREEPORT RD STE 2A
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City | FREEPORT
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State | ME
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Zip | 04032-6145
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Country | US
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Telephone | 207-307-0958
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Fax | 207-512-5909
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 2105
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2105
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License Number State | ME
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