MEDICARE: JOSHUA TIMOTHY KENNY CPO

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	222Z00000X	Orthotist	ORT00000000304	TN
2	224P00000X	Prosthetist	PRO00000000296	TN

General Provider Information

NPI Number	:	1649069501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA TIMOTHY KENNY CPO

Provider Business Mailing Address
First Line	:	622 W 1ST NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4544
Country	:	US
Telephone Number	:	423-307-1890
Fax Number	:	423-307-1891

Provider Business Practice Location Address
First Line	:	622 W 1ST NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4544
Country	:	US
Telephone Number	:	423-307-1890
Fax Number	:	423-307-1891

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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