Basic Information
| Provider Information | |||||||||
| NPI: | 1679879571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | JESSA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13691 COLORADO BLVD STE 106 | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034262580 | ||||||||
| FaxNumber: | 3034262590 | ||||||||
| Practice Location | |||||||||
| Address1: | 13691 COLORADO BLVD STE 106 | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806027068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034262580 | ||||||||
| FaxNumber: | 3034262590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2011 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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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 | 163W00000X | 188050 | CO | N | Nursing Service Providers | Registered Nurse | 363LX0001X | NP-990139 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.