Provider Demographics
NPI:1811340714
Name:KENNY, SEAN (EMT-1, CFT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:KENNY
Suffix:
Gender:M
Credentials:EMT-1, CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7012
Mailing Address - Country:US
Mailing Address - Phone:661-716-7118
Mailing Address - Fax:
Practice Address - Street 1:12308 HIGH COUNTRY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6842
Practice Address - Country:US
Practice Address - Phone:661-716-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE056693146N00000X
174H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No172V00000XOther Service ProvidersCommunity Health Worker