Provider Demographics
NPI:1457979171
Name:KENNEDY, JASON HARVEY (CNM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:HARVEY
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 20TH ST APT 14E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7637
Mailing Address - Country:US
Mailing Address - Phone:415-994-7718
Mailing Address - Fax:
Practice Address - Street 1:601 E 20TH ST APT 14E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7637
Practice Address - Country:US
Practice Address - Phone:415-994-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife