Provider Demographics
NPI:1467406769
Name:KENNEDY, BARBARA J (APN,C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1323
Mailing Address - Country:US
Mailing Address - Phone:609-645-7700
Mailing Address - Fax:609-272-8490
Practice Address - Street 1:201 SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2319
Practice Address - Country:US
Practice Address - Phone:609-645-7700
Practice Address - Fax:609-272-8490
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09780200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily