Provider Demographics
NPI:1831386028
Name:KENNY, KATHLEEN ANNE (CNM, PMHNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:KENNY
Suffix:
Gender:F
Credentials:CNM, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 GREENWOOD AVE N # 218
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4627
Mailing Address - Country:US
Mailing Address - Phone:206-300-2538
Mailing Address - Fax:206-649-7098
Practice Address - Street 1:22722 29TH DR SE STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4420
Practice Address - Country:US
Practice Address - Phone:206-300-2538
Practice Address - Fax:206-649-7098
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006613367A00000X
WAAP61095962363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0252114OtherL&I
WA1831386028Medicaid
WA0252114OtherL&I