Doctor Name: | MRS. BILLIE JO KENNETT |
NPI Number: | 1124085519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | APN0000005195 |
Business Practice Address: | 215 Hawks Rd Suite 6 Martin, TN - 382372708 |
Business Phone Number: | 7315873454 |
Business Fax Number: | 7315873460 |
Mailing Address: | 215 Hawks Rd, Suite 6 MARTIN |
State: | TN |
Postal Code: | 382372708 |
Phone Number: | 7315873454 |
Fax Number: | 7315873460 |
NPI Enumeration Date: | 04/28/2006 |
NPI Last Update Date: | 03/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | APN0000005195 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |