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NPI Code Detail

MEDICARE: JESSICA KENNEDY

MEDICARE: JESSICA KENNEDY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1083467856
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KENNEDY
Provider Business Mailing Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 951-232-3870
Fax Number :
Provider Business Practice Location Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 951-232-3870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2024
Last Update Date : 04/12/2024

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Directions to “ JESSICA KENNEDY ” Practice Location

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