Provider Demographics
NPI:1104842806
Name:KENNEY, JANICE R (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:KENNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 E THOMAS RD
Mailing Address - Street 2:100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5844
Mailing Address - Country:US
Mailing Address - Phone:602-954-0444
Mailing Address - Fax:602-952-7146
Practice Address - Street 1:8111 E THOMAS RD
Practice Address - Street 2:100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5844
Practice Address - Country:US
Practice Address - Phone:602-954-0444
Practice Address - Fax:602-952-7146
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNP12363LA2200X
AZNP183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60901Medicare ID - Type UnspecifiedMEDICARE
AZ598867Medicare UPIN