Provider Demographics
NPI:1194199331
Name:KENNY, MEGAN (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9697 191ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8609
Mailing Address - Country:US
Mailing Address - Phone:630-646-6540
Mailing Address - Fax:630-646-6542
Practice Address - Street 1:9697 191ST ST STE 100
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8609
Practice Address - Country:US
Practice Address - Phone:630-646-6540
Practice Address - Fax:630-646-6542
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041389955163WP0808X
IL209013659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health