Provider Demographics
NPI:1790894426
Name:KENNEDY, LYNN A (CNM, DNP)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KUENZLI ST STE 202
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0837
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:975 RYLAND ST STE 105
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1668
Practice Address - Country:US
Practice Address - Phone:775-982-5640
Practice Address - Fax:775-982-5641
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ094968367A00000X
NVAPRN001758367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351651Medicaid
AZZ133816Medicare PIN
AZZ132997Medicare PIN
AZ351651Medicaid