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General NPI Number Information
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NPI Number | 1760491435
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Entity Type | Individual
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Provider Name | PHYLLIS CECILIA KENNEDY ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 1897 PALM BEACH LAKES BLVD SUITE 222
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3507
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Country | US
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Telephone | 561-719-2385
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Fax | 561-659-2825
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Provider Business Mailing Address
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Address Line | 1897 PALM BEACH LAKES BLVD SUITE 222
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3507
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Country | US
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Telephone | 561-719-2385
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Fax | 561-659-2825
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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 | ARNP2594912
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License Number State | FL
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