Individual
MRS. MARYANN KENNESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1895 KINGSLEY AVE STE 903, ORANGE PARK, FL 32073-4410
(904) 644-8353
(904) 644-8289
Mailing address
10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223-6612
(904) 260-3022
(904) 260-3947
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
35098042
OH
208800000X
Urology Physician
Primary
ME92864
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056336
—
OH
05
—
006734700
—
FL
01
—
14N6L
BCBS
FL
Enumeration date
10/21/2009
Last updated
02/13/2018
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