Provider Demographics
NPI:1174671267
Name:KENNY, CHRISTINE (DNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 NW ESTUARY CT
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-8808
Mailing Address - Country:US
Mailing Address - Phone:917-575-1890
Mailing Address - Fax:
Practice Address - Street 1:1165 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2907
Practice Address - Country:US
Practice Address - Phone:772-255-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9535939363L00000X
FLAPRN11007630363LA2200X
NY303770363LA2200X
NYF340280363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology