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NPI Code Detail

MEDICARE: DR. JOHN MICHAEL KENNY M.D.

MEDICARE: DR. JOHN MICHAEL KENNY M.D.
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
12084P0800XPsychiatry Physician52896KY
22084P0800XPsychiatry PhysicianQ6338TX
32084P0800XPsychiatry PhysicianMED-PHYS-LIC-91589MT
42084P0800XPsychiatry Physician51181AZ
52084P0800XPsychiatry PhysicianME154143FL
62084P0800XPsychiatry Physician69834CT
72084P0800XPsychiatry PhysicianM-15356ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1316418767OTHERNYUNITED
2824114000OTHERNYMAGELLAN
37501836OTHERNYAETNA
4P3619670OTHERNYOXFORD

General Provider Information

NPI Number : 1750449732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN MICHAEL KENNY M.D.
Provider Business Mailing Address
First Line : 1768 BUSINESS CENTER DR STE 100
Second Line :
City : RESTON
State : VA
Zip : 20190-5359
Country : US
Telephone Number : 800-762-9244
Fax Number : 786-672-6006
Provider Business Practice Location Address
First Line : 14200 W CELEBRATE LIFE WAY
Second Line :
City : GOODYEAR
State : AZ
Zip : 85338-3007
Country : US
Telephone Number : 623-207-3415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 06/05/2026

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