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General NPI Number Information
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NPI Number | 1265664668
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Entity Type | Individual
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Provider Name | KRISTEN NOEL KENNERLEY A.P.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 1413 S PATRICK DR SUITE 4
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4373
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Country | US
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Telephone | 321-960-6959
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Fax | 321-622-8919
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Provider Business Mailing Address
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Address Line | 1595 YORKTOWN AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-1533
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Country | US
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Telephone | 321-506-9332
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 2724
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License Number State | FL
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