Provider Demographics
NPI:1538129762
Name:KENNEDY, BEVERLY M (ARNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-2799
Mailing Address - Fax:603-577-5674
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-3053
Practice Address - Fax:603-577-5354
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039588-23-04363LW0102X
NH039588-23363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH043775640OtherPHCS
NV043775640OtherHCVM/FIRST HEALTH
NH4005898Y0NH02OtherANTHEM BCBS NH
MANP0469OtherBCBSMA
MANP0469OtherBCBSMA
NHS03027Medicare UPIN
NH043775640OtherPHCS
NH30011472Medicaid
NH043775640OtherPHCS