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General NPI Number Information
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NPI Number | 1588207658
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Entity Type | Individual
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Provider Name | BILLIE KENNEDY NP
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Gender | Female
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 400 MATTHEW ST STE 305
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City | MARIETTA
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State | OH
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Zip | 45750-1600
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Country | US
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Telephone | 740-568-5662
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Fax | 740-568-5672
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Provider Business Mailing Address
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Address Line | 1100 CENTRAL AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4930
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Country | US
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Telephone | 505-724-6917
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 58141
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0026979
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License Number State | OH
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