Provider Demographics
NPI:1053831578
Name:KENNEY, JAMIE LEEANN (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEEANN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEEANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 SUPERIOR AVE E STE 214
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4169
Practice Address - Country:US
Practice Address - Phone:330-535-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily