Provider Demographics
NPI:1619475548
Name:KENNING, JUDITH ANN (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
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 1:4188 WINNS HOLLOW LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8429
Mailing Address - Country:US
Mailing Address - Phone:360-320-8098
Mailing Address - Fax:
Practice Address - Street 1:4188 WINNS HOLLOW LN UNIT 1
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8429
Practice Address - Country:US
Practice Address - Phone:360-320-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00130719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse