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General NPI Number Information
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NPI Number | 1902547045
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Entity Type | Individual
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Provider Name | DESIREE ELIZABETH KENNEDY APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1350 HICKORY ST STE 101
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City | MELBOURNE
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State | FL
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Zip | 32901-3224
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Country | US
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Telephone | 321-434-3644
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Fax | 321-434-3438
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-434-3644
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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 | APRN11019009
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License Number State | FL
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