MEDICARE: LESLEY H. KENNEDY CNM

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	163W00000X	Registered Nurse	RN00089640	WA
2	367A00000X	Advanced Practice Midwife	AP30001702	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275642084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY H. KENNEDY CNM

Provider Business Mailing Address
First Line	:	PO BOX 3835
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-3835
Country	:	US
Telephone Number	:	206-548-3114
Fax Number	:	206-762-6355

Provider Business Practice Location Address
First Line	:	10521 MERIDIAN AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-9509
Country	:	US
Telephone Number	:	206-296-4990
Fax Number	:	206-205-5142

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/11/2016

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