Individual
MARK S KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP-BC
Contact information
Practice address
1355 ROCKETDYNE RD, NEOSHO, MO 64850-3106
(417) 451-7425
(417) 451-7455
Mailing address
PO BOX 4725, JOPLIN, MO 64803-4725
(417) 451-7425
(417) 451-7455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
45922
KS
363L00000X
Nurse Practitioner
66851
OK
363LF0000X
Family Nurse Practitioner
Primary
141364
MO
Other
Enumeration date
03/07/2007
Last updated
10/05/2018
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