Provider Demographics
NPI:1912662099
Name:KENNO, MELISSA JANE (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:KENNO
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:SHROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP, FNP-C
Mailing Address - Street 1:810 SIR THOMAS CT STE 101
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-614-4420
Mailing Address - Fax:
Practice Address - Street 1:810 SIR THOMAS CT STE 101
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-614-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-07-25
Deactivation Date:2022-06-23
Deactivation Code:
Reactivation Date:2022-07-19
Provider Licenses
StateLicense IDTaxonomies
PARN683096163W00000X
PASP025939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse