Basic Information
| Provider Information | |||||||||
| NPI: | 1124530126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | JAMIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6545 STATE ROUTE 201 | ||||||||
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| City: | TIPP CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453718799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376630138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1343 N FOUNTAIN BLVD STE 250 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455041479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375239050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.021877 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.