Provider Demographics
NPI:1902845647
Name:KENNEY, KRISTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4911
Mailing Address - Country:US
Mailing Address - Phone:614-899-2838
Mailing Address - Fax:614-899-2872
Practice Address - Street 1:900 CLUB DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4911
Practice Address - Country:US
Practice Address - Phone:614-899-2838
Practice Address - Fax:614-899-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084218-K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI35210Medicare UPIN