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General NPI Number Information
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NPI Number | 1538635065
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Entity Type | Individual
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Provider Name | SAVANNAH LEA KENNY FNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 202 LAWRENCE LN
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City | YREKA
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State | CA
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Zip | 96097-3341
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Country | US
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Telephone | 530-572-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 616 JACKSON ST
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City | YREKA
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State | CA
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Zip | 96097-2826
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NP95009922
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License Number State | CA
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