Doctor Name: | MARY E KENNY |
NPI Number: | 1841215373 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 001071631 |
Business Practice Address: | 18765 Riverside Drive Vansant, VA - 24656 |
Business Phone Number: | 2769352880 |
Business Fax Number: | 2769352889 |
Mailing Address: | 194 #10 Coal Camp, CLINCHCO |
State: | VA |
Postal Code: | 24226 |
Phone Number: | 2768359312 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2006 |
NPI Last Update Date: | 09/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 001071631 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |