Provider Demographics
NPI:1538760277
Name:KENNEDY, JENNIFER MICHELLE (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:KENNEDY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-247-7795
Mailing Address - Fax:800-574-6540
Practice Address - Street 1:1029 MEDICAL CENTER CIR STE 202
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1189
Practice Address - Country:US
Practice Address - Phone:270-247-7795
Practice Address - Fax:270-251-4551
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100747480Medicaid