Provider Demographics
NPI:1649064411
Name:KENNEY, ELIZABETH JANE (PNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:KENNEY
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1229
Mailing Address - Country:US
Mailing Address - Phone:631-316-9527
Mailing Address - Fax:
Practice Address - Street 1:2799 ROUTE 112 STE 7&11
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2535
Practice Address - Country:US
Practice Address - Phone:631-732-5222
Practice Address - Fax:631-732-6222
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383766-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics