MEDICARE: KIERAN 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
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN61181136	WA

General Provider Information

NPI Number	:	1144901489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERAN KENNEDY

Provider Business Mailing Address
First Line	:	7709 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1840
Country	:	US
Telephone Number	:	206-372-8257
Fax Number	:

Provider Business Practice Location Address
First Line	:	7709 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1840
Country	:	US
Telephone Number	:	206-372-8257
Fax Number	:

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

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	07/28/2023

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Directions to “ KIERAN KENNEDY ” Practice Location

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