MEDICARE: MR. JOHN ANDREW KENNEY EMT-PARAMEDIC

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	146L00000X	Paramedic	051527	CO

General Provider Information

NPI Number	:	1497018691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ANDREW KENNEY EMT-PARAMEDIC

Provider Business Mailing Address
First Line	:	6268 SPRING VALLEY RD
Second Line	:
City	:	TIMNATH
State	:	CO
Zip	:	80547-2506
Country	:	US
Telephone Number	:	970-690-9057
Fax Number	:

Provider Business Practice Location Address
First Line	:	6268 SPRING VALLEY RD
Second Line	:
City	:	TIMNATH
State	:	CO
Zip	:	80547-2506
Country	:	US
Telephone Number	:	970-690-9057
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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