Provider Demographics
NPI:1558462598
Name:KENNING, JERI L (RN)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:L
Last Name:KENNING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MULBERRY ST
Mailing Address - Street 2:STE 201
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1231
Mailing Address - Country:US
Mailing Address - Phone:812-435-5725
Mailing Address - Fax:812-435-5418
Practice Address - Street 1:420 MULBERRY ST
Practice Address - Street 2:STE 201
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1231
Practice Address - Country:US
Practice Address - Phone:812-435-5725
Practice Address - Fax:812-435-5418
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104101A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse