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General NPI Number Information
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NPI Number | 1528298288
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Entity Type | Individual
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Provider Name | JAE M KENNEDY-COOKSON APRN-CNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 27475 HOLIDAY LN STE 2
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City | PERRYSBURG
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State | OH
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Zip | 43551-3350
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Country | US
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Telephone | 419-872-0619
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Fax |
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Provider Business Mailing Address
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Address Line | 27475 HOLIDAY LN
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City | PERRYSBURG
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State | OH
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Zip | 43551-3350
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Country | US
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Telephone | 614-787-8187
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1457548224
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License Number State | OH
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