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General NPI Number Information
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NPI Number | 1528573573
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Entity Type | Individual
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Provider Name | VICTORIA KING KENNEDY CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 11448 ALABASTER DR
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City | DAPHNE
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State | AL
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Zip | 36526-3408
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Country | US
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Telephone | 251-229-2233
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Fax | 251-257-5043
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Provider Business Mailing Address
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Address Line | 11448 ALABASTER DR
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City | DAPHNE
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State | AL
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Zip | 36526-3408
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Country | US
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Telephone | 251-229-2233
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Fax | 251-257-5043
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1-129596
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License Number State | AL
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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 | APRN11014337
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-129596
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License Number State | AL
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