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General NPI Number Information
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NPI Number | 1083949986
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Entity Type | Individual
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Provider Name | KERRY MARIE KENNEDY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 7066 STILLWATER BLVD N
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City | OAKDALE
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State | MN
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Zip | 55128-3937
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Country | US
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Telephone | 612-227-3075
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Fax | 651-251-5128
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Provider Business Mailing Address
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Address Line | 7066 STILLWATER BLVD N
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City | OAKDALE
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State | MN
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Zip | 55128-3937
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Country | US
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Telephone | 651-251-5044
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Fax | 651-251-5128
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | R123669
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0908
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License Number State | MN
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