Basic Information
| Provider Information | |||||||||
| NPI: | 1578086559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENEDY | ||||||||
| FirstName: | SUZANNE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 N MILPAS ST | ||||||||
| Address2: | FL 2 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177850 | ||||||||
| FaxNumber: | 8059638880 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 N MILPAS ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177858 | ||||||||
| FaxNumber: | 8059638880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2017 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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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 | 95006918 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.