Provider Demographics
NPI:1801971767
Name:KENNEDY, JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16440 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7807
Mailing Address - Country:US
Mailing Address - Phone:480-706-7936
Mailing Address - Fax:480-706-7976
Practice Address - Street 1:16440 S 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7807
Practice Address - Country:US
Practice Address - Phone:480-706-7936
Practice Address - Fax:480-706-7976
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool