Provider Demographics
NPI:1902984800
Name:KENNEY, TERESA ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 BURT CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2094
Mailing Address - Country:US
Mailing Address - Phone:402-991-3393
Mailing Address - Fax:402-991-3390
Practice Address - Street 1:10506 BURT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2094
Practice Address - Country:US
Practice Address - Phone:402-991-3393
Practice Address - Fax:402-991-3390
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54025163W00000X
NE110425363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47067556113Medicaid
P27209Medicare UPIN