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NPI Code Detail

MEDICARE: IRINA KIM KENNEDY NP

MEDICARE: IRINA KIM KENNEDY NP
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
1363LF0000XFamily Nurse Practitioner39104TN
2363LF0000XFamily Nurse Practitioner1071074TX

General Provider Information

NPI Number : 1598496937
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRINA KIM KENNEDY NP
Provider Business Mailing Address
First Line : PO BOX 7411009
Second Line :
City : CHICAGO
State : IL
Zip : 60674-3009
Country : US
Telephone Number : 609-585-1122
Fax Number : 606-585-0309
Provider Business Practice Location Address
First Line : 1 MEDICAL CENTER BLVD
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-4294
Country : US
Telephone Number : 609-585-1122
Fax Number : 609-585-0309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2022
Last Update Date : 03/02/2026

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