Individual
JANICE MARIE KENNESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
21159 PAINT BLVD, SUITE 2, SHIPPENVILLE, PA 16254-4023
(814) 226-6770
(814) 226-1015
Mailing address
121 DOCTORS LN, CLARION, PA 16214-8515
(814) 226-3470
(814) 226-3479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS008701L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015179590006
—
PA
01
—
777963
BLUE SHIELD
PA
01
—
95223
UNISON
PA
01
—
P00063069
RAILROAD MEDICARE
PA
01
—
P001040
GATEWAY
PA
Enumeration date
02/23/2006
Last updated
07/08/2007
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