Individual
JERONE DANUEL KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(757) 388-6115
(757) 388-6116
Mailing address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 240-2829
(757) 388-6116
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
0101254590
VA
207T00000X
Neurological Surgery Physician
Primary
39807
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39807
MINNESOTA BOARD OF MEDICINE
MN
01
—
53379020
WISCONSIN MEDICAL BOARD
WI
Enumeration date
03/25/2006
Last updated
03/27/2023
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