Doctor Name: | KIMBERLY ROSE MCKENNA |
NPI Number: | 1295810786 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | 4091P |
Business Practice Address: | 101 Winston Way Suite E Campbellsville, KY - 427184963 |
Business Phone Number: | 2707890034 |
Business Fax Number: | 2707890097 |
Mailing Address: | 101 Winston Way, Suite E CAMPBELLSVILLE |
State: | KY |
Postal Code: | 427184963 |
Phone Number: | 2707890034 |
Fax Number: | 2707890097 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 12/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4091P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |