Provider Demographics
NPI:1275009441
Name:KENNEDY, ANNA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1933
Mailing Address - Country:US
Mailing Address - Phone:757-679-8981
Mailing Address - Fax:
Practice Address - Street 1:331 OAK MANOR DR STE 203
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5555
Practice Address - Country:US
Practice Address - Phone:410-768-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176797363LF0000X
WAAP60858241363LF0000X
MDAC002558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily