Provider Demographics
NPI:1770258717
Name:KENNETT, ANNAH RUTH (NP)
Entity type:Individual
Prefix:
First Name:ANNAH
Middle Name:RUTH
Last Name:KENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7253
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-0101
Mailing Address - Country:US
Mailing Address - Phone:720-340-8244
Mailing Address - Fax:888-575-9310
Practice Address - Street 1:80 BIG SPRINGS DR
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466-5345
Practice Address - Country:US
Practice Address - Phone:720-340-8244
Practice Address - Fax:888-575-9310
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996806-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health