MEDICARE: JENNIFER 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	163WS0200X	School Registered Nurse	581406	NY

General Provider Information

NPI Number	:	1366380800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KENNEDY

Provider Business Mailing Address
First Line	:	34 ORCHARD DR
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-1352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2914
Country	:	US
Telephone Number	:	518-824-1600
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ JENNIFER KENNEDY ” Practice Location

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