MEDICARE: MS. LAURIE KENNEDY APRN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	004234	CT

General Provider Information

NPI Number	:	1144559543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE KENNEDY APRN

Provider Business Mailing Address
First Line	:	8 HARWICH LN
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1436
Country	:	US
Telephone Number	:	860-231-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 HARWICH LN
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1436
Country	:	US
Telephone Number	:	860-231-0222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	11/01/2018

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