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1649064411 NPI number — ELIZABETH JANE KENNEY PNP

NPI Number: 1649064411
Health Care Provider/Practitioner: ELIZABETH JANE KENNEY PNP

Information about “1649064411” NPI (ELIZABETH JANE KENNEY PNP) exists in 1649064411 in HTML format HTML  |  1649064411 in plain Text format TXT  |  1649064411 in PDF (Portable Document Format) PDF  |  1649064411 in an XML format XML  formats.

NPI Number : 1649064411 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649064411",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KENNEY",
    "FirstName": "ELIZABETH",
    "MiddleName": "JANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "75 TERRACE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST NORTHPORT",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11731-1229",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-316-9527",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2799 ROUTE 112 STE 7&11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEDFORD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11763-2535",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-732-5222",
    "PracticeLocationAddressFaxNumber": "631-732-6222",
    "EnumerationDate": "04/07/2025",
    "LastUpdateDate": "04/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0200X",
        "TaxonomyName": "Pediatric Nurse Practitioner",
        "LicenseNumber": "F383766-01",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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