Provider Demographics
NPI:1952747446
Name:HENNESSEY, KERRILYNN CARNEY (MD)
Entity Type:Individual
Prefix:
First Name:KERRILYNN
Middle Name:CARNEY
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRILYNN
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:DEPARTMENT OF CARDIOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756
Mailing Address - Country:US
Mailing Address - Phone:603-650-6171
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:DEPARTMENT OF CARDIOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-650-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277643207R00000X
NH20640207RC0000X
CT58713390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease