Provider Demographics
NPI:1063471308
Name:KENNEDY, AMIE E (CNM)
Entity Type:Individual
Prefix:MS
First Name:AMIE
Middle Name:E
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9362
Mailing Address - Country:US
Mailing Address - Phone:570-523-8700
Mailing Address - Fax:570-523-8705
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 312
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-523-8700
Practice Address - Fax:570-523-8705
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008401L367A00000X
VT1010014447367A00000X
NY001395367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
R74625Medicare UPIN
NYJ400023584Medicare UPIN