Provider Demographics
NPI:1093701583
Name:KENNY, KATHERINE J (ANP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:KENNY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:J
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:350 W THOMAS RD
Mailing Address - Street 2:BUILDING 3033B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4409
Mailing Address - Country:US
Mailing Address - Phone:602-406-3532
Mailing Address - Fax:602-406-4974
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:BUILDING 3033B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3532
Practice Address - Fax:602-406-4974
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN053792163W00000X
AZANP224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62969Medicare ID - Type Unspecified
P13877Medicare UPIN