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General NPI Number Information
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NPI Number | 1518147776
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Entity Type | Individual
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Provider Name | AMY A KENNEMORE RN, APN-BC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 1002 TEXAS BLVD STE 325
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City | TEXARKANA
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State | TX
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Zip | 75501-5118
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Country | US
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Telephone | 903-794-6544
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 LEONA DR
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City | ASHDOWN
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State | AR
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Zip | 71822-3105
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Country | US
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Telephone | 903-826-5020
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Fax | 903-764-6546
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R63145
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License Number State | AR
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