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General NPI Number Information
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NPI Number | 1356905434
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Entity Type | Individual
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Provider Name | KENLEY JEAN RN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 32 EASTPOND LN
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City | EASTPORT
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State | NY
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Zip | 11941-1303
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Country | US
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Telephone | 631-682-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 93201 CIRCLE DR
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-5229
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Country | US
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Telephone | 516-615-9151
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 323520
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 850058
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License Number State | NY
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