Provider Demographics
NPI:1497228522
Name:KENNEY, VANESSA (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:PETITTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:25 PARK LANE SOUTH UNIT 2003
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:646-771-8776
Mailing Address - Fax:
Practice Address - Street 1:28A MELISSA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7439
Practice Address - Country:US
Practice Address - Phone:646-771-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily