Individual
JAN MARIE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1813 BELTLINE RD SW, DECATUR, AL 35601-5506
(256) 353-6874
(256) 260-0594
Mailing address
PO BOX 5689, 1813 BELTLINE RD SW, DECATUR, AL 35601-0689
(256) 353-6874
(256) 260-0594
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1076407
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-076407
ALABAMA LICENSE
AL
01
—
51533376
BCBS
AL
Enumeration date
05/10/2006
Last updated
08/17/2010
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