Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NR15415200 | NJ |
N | 363LA2200X | Nurse Practitioner - Adult Health | 415907-1 | NY |
N | 363LW0102X | Nurse Practitioner - Women's Health | 415907-1 | NY |
NPI | 1003802729 |
---|---|
Provider Name | Ms. Kristi A. Kennedy |
First Address | Camden, NJ 08103-1088 |
Second Address | Voorhees, NJ 08043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 03/04/2019 |