Provider Demographics
NPI:1790233765
Name:KENNEDY, GENEVA NOELLE (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:NOELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MISS
Other - First Name:GENEVA
Other - Middle Name:NOELLE
Other - Last Name:KNUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 ROBERT ST
Mailing Address - Street 2:APARTMENT 6
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2539
Mailing Address - Country:US
Mailing Address - Phone:858-705-3139
Mailing Address - Fax:
Practice Address - Street 1:7695 CARDINAL CT STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-9378
Practice Address - Fax:858-277-9370
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303029363LW0102X, 163W00000X
CA95102883163W00000X
CANPF95005449363LW0102X
MANP95005449363LX0001X
CAN95005449363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology