Provider Demographics
NPI:1861507840
Name:KENNEY, ANNETTE F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:F
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:F
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2255 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2522
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:3515 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3529
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-789-7222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01296185Medicaid
CO01296185Medicaid
COF72720Medicare PIN
CO424444YL7XMedicare PIN