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NPI Code Detail

MEDICARE: MORIAH JESSICA KENNEDY

MEDICARE: MORIAH JESSICA KENNEDY
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1912823816
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORIAH JESSICA KENNEDY
Provider Business Mailing Address
First Line : 133 BENMORE DRIVE
Second Line : SUITE 201
City : WINTER PARK
State : FL
Zip : 32792-3273
Country : US
Telephone Number : 407-646-7757
Fax Number : 407-646-7775
Provider Business Practice Location Address
First Line : 133 BENMORE DRIVE
Second Line : SUITE 201
City : WINTER PARK
State : FL
Zip : 32792-3273
Country : US
Telephone Number : 407-646-7757
Fax Number : 407-646-7775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2026
Last Update Date : 06/25/2026

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