Basic Information
| Provider Information | |||||||||
| NPI: | 1932558327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | ANNE MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 CAPEHART RD | ||||||||
| Address2: | |||||||||
| City: | OFFUTT AFB | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681131043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022942056 | ||||||||
| FaxNumber: | 4022328856 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 CAPEHART RD STE 1K47 | ||||||||
| Address2: | |||||||||
| City: | OFFUTT AFB | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681131045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508838600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2016 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1750 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.