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General NPI Number Information
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NPI Number | 1568883429
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Entity Type | Organization
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Legal Business Name | KENNEBUNK FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 9 HIGH ST
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City | KENNEBUNK
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State | ME
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Zip | 04043-7164
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Country | US
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Telephone | 207-502-7220
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Fax | 207-502-7220
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Provider Business Mailing Address
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Address Line | 103 SUMMER ST
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City | KENNEBUNK
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State | ME
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Zip | 04043-6613
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Country | US
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Telephone | 207-229-5789
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Fax | 207-502-7221
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MS. CECILY CANNON
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Credential | DO
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Telephone | 207-229-5789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2043
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License Number State | ME
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