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NPI Code Detail

MEDICARE: MRS. THERESA K KENNON FNP-BC

MEDICARE: MRS. THERESA K KENNON FNP-BC
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
1363LF0000XFamily Nurse Practitioner162389AK

General Provider Information

NPI Number : 1962523530
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA K KENNON FNP-BC
Provider Business Mailing Address
First Line : 7033 E TUDOR RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1262
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4330 ELMORE RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-5907
Country : US
Telephone Number : 907-729-6690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 02/10/2026

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Directions to “ MRS. THERESA K KENNON FNP-BC” Practice Location

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