Provider Demographics
NPI:1588207658
Name:KENNEDY, BILLIE (NP)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CENTRAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4930
Mailing Address - Country:US
Mailing Address - Phone:505-724-6917
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 305
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1600
Practice Address - Country:US
Practice Address - Phone:740-568-5662
Practice Address - Fax:740-568-5672
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM58141363L00000X
OHAPRN.CNP.0026979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner