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General NPI Number Information
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NPI Number | 1275249088
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Entity Type | Individual
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Provider Name | ANGELA D KENNERLY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 213 W MAIN ST
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City | NEW ROADS
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State | LA
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Zip | 70760-3511
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Country | US
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Telephone | 225-242-9162
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Fax | 833-972-7844
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | GEISMAR
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State | LA
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Zip | 70734-0477
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Country | US
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Telephone | 225-242-9162
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Fax | 225-495-4144
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 229265
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License Number State | LA
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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 | 229265
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License Number State | LA
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