Provider Demographics
NPI:1831066679
Name:KENNAN, JESSICA ALICE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:KENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10378 SW MUKAI CIR
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-3755
Mailing Address - Country:US
Mailing Address - Phone:206-322-3277
Mailing Address - Fax:
Practice Address - Street 1:10378 SW MUKAI CIR
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-3755
Practice Address - Country:US
Practice Address - Phone:206-322-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABDC-BD-70016004374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula