Provider Demographics
NPI:1063031854
Name:KENNING, JESSICA (MAT, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KENNING
Suffix:
Gender:F
Credentials:MAT, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HARRIS KENNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2667 BRUTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-5753
Mailing Address - Country:US
Mailing Address - Phone:407-206-8717
Mailing Address - Fax:
Practice Address - Street 1:2667 BRUTON BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-5753
Practice Address - Country:US
Practice Address - Phone:407-206-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63172255A2300X
390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program