Provider Demographics
NPI:1033255765
Name:KENNEDY, JILL MARIE (WHCNP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5750 PINELAND DR STE 240
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5300
Mailing Address - Country:US
Mailing Address - Phone:469-637-2777
Mailing Address - Fax:469-637-2760
Practice Address - Street 1:5750 PINELAND DR., STE #240
Practice Address - Street 2:SUITE 206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4534
Practice Address - Country:US
Practice Address - Phone:469-637-2777
Practice Address - Fax:469-637-2760
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP105620363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health