Individual
MS. KERRY MARIE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(612) 227-3075
(651) 251-5128
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 251-5044
(651) 251-5128
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
R123669
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0908
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500005583
MEDICARE PTAN
MN
Enumeration date
10/09/2009
Last updated
01/26/2022
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