Provider Demographics
NPI:1245066299
Name:KENNEDY, ANNA (RN, MSN, PCCN, ACCNS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN, MSN, PCCN, ACCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 KONHAUS RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3126
Mailing Address - Country:US
Mailing Address - Phone:717-991-8589
Mailing Address - Fax:
Practice Address - Street 1:2160 STATE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1812
Practice Address - Country:US
Practice Address - Phone:717-318-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN671952163WM0705X
PACNS000387364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical