Individual
TANYA F KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1106 HAZEL LN, FARMINGTON, MO 63640-1999
(573) 756-6751
(573) 756-6807
Mailing address
PO BOX 957683, SAINT LOUIS, MO 63195-7683
(573) 366-6149
(573) 756-6807
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2016032673
MO
363LF0000X
Family Nurse Practitioner
2016032673
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016032673
STATE FNP LICENSE
MO
Enumeration date
09/23/2016
Last updated
09/26/2025
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