Provider Demographics
NPI:1205026234
Name:KENNEY, JUDITH ANN (APN,RNFA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:APN,RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20201 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1010
Mailing Address - Country:US
Mailing Address - Phone:708-747-4000
Mailing Address - Fax:
Practice Address - Street 1:30 E 15TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-755-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical