Provider Demographics
NPI:1689969412
Name:KENNARD, ANNE KRISTEN (DOA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:KRISTEN
Last Name:KENNARD
Suffix:
Gender:F
Credentials:DOA
Other - Prefix:
Other - First Name:AMME
Other - Middle Name:
Other - Last Name:BONSANGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 S PALISADE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8903
Mailing Address - Country:US
Mailing Address - Phone:805-354-7101
Mailing Address - Fax:805-354-7102
Practice Address - Street 1:220 S. PALISADE DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-354-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1928207V00000X
CA13574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology