Basic Information
Provider Information
NPI: 1003802729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KENNEDY
FirstName: KRISTI
MiddleName: A.
NamePrefix: MS.
NameSuffix:  
Credential: WHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FEDERAL ST # 200
Address2:  
City: CAMDEN
State: NJ
PostalCode: 081031088
CountryCode: US
TelephoneNumber: 8563564924
FaxNumber:  
Practice Location
Address1: 900 CENTENNIAL BLVD STE M
Address2:  
City: VOORHEES
State: NJ
PostalCode: 08043
CountryCode: US
TelephoneNumber: 8556322667
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 04/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X26NR15415200NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LA2200X415907-1NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LW0102X415907-1NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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