Provider Demographics
NPI:1700952132
Name:KENNEDY, EILEEN FRANCES (NP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FRANCES
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:KENNEDY
Other - Last Name:MORTERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-8712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8756
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-6100
Practice Address - Fax:816-931-1786
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141535363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner