Provider Demographics
NPI:1245883974
Name:KENNEDY, MOLLY K (FNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ERIE CANAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4609
Mailing Address - Country:US
Mailing Address - Phone:585-865-8210
Mailing Address - Fax:585-865-7597
Practice Address - Street 1:120 ERIE CANAL DR STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4609
Practice Address - Country:US
Practice Address - Phone:585-865-8210
Practice Address - Fax:585-865-7597
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily