Basic Information
| Provider Information | |||||||||
| NPI: | 1245883974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | MOLLY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 RIDGEWAY AVE STE 480 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5858658210 | ||||||||
| FaxNumber: | 5858657597 | ||||||||
| Practice Location | |||||||||
| Address1: | 2655 RIDGEWAY AVE STE 480 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5858658210 | ||||||||
| FaxNumber: | 5858657597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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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 | 344144 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.