Individual
NICOLE KENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2715 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-3981
(417) 889-0056
Mailing address
PO BOX 505673, SAINT LOUIS, MO 63150-5673
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2008023403
MO
363LF0000X
Family Nurse Practitioner
Primary
2016034602
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
08/31/2016
Last updated
09/27/2024
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