Provider Demographics
NPI:1811071905
Name:KENNY, COLEEN P (NP)
Entity type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:P
Last Name:KENNY
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 1:5540 FALMOUTH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1800
Mailing Address - Country:US
Mailing Address - Phone:804-288-1111
Mailing Address - Fax:804-288-1112
Practice Address - Street 1:5540 FALMOUTH ST STE 307
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1800
Practice Address - Country:US
Practice Address - Phone:804-288-1111
Practice Address - Fax:804-288-1112
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024120245363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008925364Medicaid
VA008925364Medicaid
VAS53326Medicare UPIN