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General NPI Number Information
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NPI Number | 1649455718
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Entity Type | Individual
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Provider Name | JENNIFER WING KENNEDY CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1875 CENTURY BLVD NE STE 150
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City | ATLANTA
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State | GA
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Zip | 30345-3323
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Country | US
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Telephone | 404-633-4595
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Fax | 404-633-6637
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Provider Business Mailing Address
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Address Line | 403 S CANDLER ST
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City | DECATUR
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State | GA
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Zip | 30030-3748
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Country | US
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Telephone | 207-831-9127
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN193467
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP193467
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License Number State | GA
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