Provider Demographics
NPI:1700555778
Name:KENNEDY, JESSICA FRANCES (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRANCES
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 1:32248 BRETTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1541
Mailing Address - Country:US
Mailing Address - Phone:248-982-0192
Mailing Address - Fax:
Practice Address - Street 1:32248 BRETTON ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1541
Practice Address - Country:US
Practice Address - Phone:248-982-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317013NSA210L4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily