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General NPI Number Information
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NPI Number | 1750175535
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Entity Type | Individual
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Provider Name | ROVENA R KENNEDY LDO
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 3050 E STATE ROUTE 69
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City | PRESCOTT
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State | AZ
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Zip | 86301-6740
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Country | US
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Telephone | 928-445-3933
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Fax | 928-443-8056
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Provider Business Mailing Address
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Address Line | 1365 WARBLER WAY
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City | PRESCOTT
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State | AZ
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Zip | 86305-5849
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Country | US
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Telephone | 928-503-9975
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO-002414
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License Number State | AZ
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