Provider Demographics
NPI:1548355878
Name:KEARNEY, JENNIFER ANN REGO (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN REGO
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:REGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3841 N FREEWAY BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1948
Mailing Address - Country:US
Mailing Address - Phone:916-567-3500
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C217
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1712
Practice Address - Country:US
Practice Address - Phone:858-869-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG573062084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry