MEDICARE: MS. KIMBERLEY ANNE KENNETT RN

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	163W00000X	Registered Nurse	RN 3398392	FL
2	163WC0400X	Case Management Registered Nurse	RN 3398392	FL

General Provider Information

NPI Number	:	1679758981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEY ANNE KENNETT RN

Provider Business Mailing Address
First Line	:	1741 RIVER HILLS DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003-8395
Country	:	US
Telephone Number	:	904-314-3518
Fax Number	:	904-531-9207

Provider Business Practice Location Address
First Line	:	1741 RIVER HILLS DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003-8395
Country	:	US
Telephone Number	:	904-314-3518
Fax Number	:	904-531-9207

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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