MEDICARE: PHYLLIS CECILIA KENNEDY ARNP

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	363L00000X	Nurse Practitioner	ARNP2594912	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760491435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS CECILIA KENNEDY ARNP

Provider Business Mailing Address
First Line	:	1897 PALM BEACH LAKES BLVD
Second Line	:	SUITE 222
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3507
Country	:	US
Telephone Number	:	561-719-2385
Fax Number	:	561-659-2825

Provider Business Practice Location Address
First Line	:	1897 PALM BEACH LAKES BLVD
Second Line	:	SUITE 222
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3507
Country	:	US
Telephone Number	:	561-719-2385
Fax Number	:	561-659-2825

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	09/10/2009

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