MEDICARE: TANAIRI 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	363LW0102X	Women's Health Nurse Practitioner	5382574012	KS

General Provider Information

NPI Number	:	1285408674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANAIRI KENNEDY

Provider Business Mailing Address
First Line	:	1905 159TH TER
Second Line	:
City	:	BASEHOR
State	:	KS
Zip	:	66007-8701
Country	:	US
Telephone Number	:	913-972-5097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 NE 60TH ST STE 100
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2091
Country	:	US
Telephone Number	:	816-453-6000
Fax Number	:

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

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “ TANAIRI KENNEDY ” Practice Location

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