Provider Demographics
NPI:1184629479
Name:KENNEY, COLLEEN MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 HIGH SCHOOL AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1813
Mailing Address - Country:US
Mailing Address - Phone:925-685-3117
Mailing Address - Fax:925-685-3322
Practice Address - Street 1:2485 HIGH SCHOOL AVE
Practice Address - Street 2:STE 222
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-685-3117
Practice Address - Fax:925-685-3322
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3382213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E33820Medicaid
CA0533420001Medicare NSC
CA000E33820Medicaid
CA000E33820Medicare PIN