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NPI Code Detail

MEDICARE: MS. AUDRA LEIGH KENNEDY CRNA

MEDICARE: MS. AUDRA LEIGH KENNEDY CRNA
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
1367500000XCertified Registered Nurse Anesthetist3480CA

General Provider Information

NPI Number : 1609818103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AUDRA LEIGH KENNEDY CRNA
Provider Business Mailing Address
First Line : 182 PROMONTORY DR W
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-7311
Country : US
Telephone Number : 714-421-1132
Fax Number :
Provider Business Practice Location Address
First Line : 9400 ROSECRANS AVE
Second Line :
City : BELLFLOWER
State : CA
Zip : 90706-2246
Country : US
Telephone Number : 562-461-4111
Fax Number : 562-461-4111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 12/01/2021

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