Provider Demographics
NPI:1043230907
Name:KENNEDY, VANESSA (RN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 CARPENTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2521
Mailing Address - Country:US
Mailing Address - Phone:850-377-0913
Mailing Address - Fax:888-249-2325
Practice Address - Street 1:5150 BAYOU BLVD
Practice Address - Street 2:STE 1N
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2158
Practice Address - Country:US
Practice Address - Phone:850-416-7656
Practice Address - Fax:850-416-7648
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1232762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL758350800Medicaid