MEDICARE: CHRISTINE KENNY DNP

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	363L00000X	Nurse Practitioner	RN9535939	FL
2	363LA2200X	Adult Health Nurse Practitioner	APRN11007630	FL
3	363LA2200X	Adult Health Nurse Practitioner	303770	NY
4	363LG0600X	Gerontology Nurse Practitioner	F340280	NY

General Provider Information

NPI Number	:	1174671267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KENNY DNP

Provider Business Mailing Address
First Line	:	2058 NW ESTUARY CT
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-8808
Country	:	US
Telephone Number	:	917-575-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 SW 27TH ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2907
Country	:	US
Telephone Number	:	772-255-6565
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/06/2024

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