Provider Demographics
NPI:1124085519
Name:KENNETT, BILLIE JO (APN)
Entity type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:JO
Last Name:KENNETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HAWKS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2708
Mailing Address - Country:US
Mailing Address - Phone:731-587-3454
Mailing Address - Fax:731-587-3460
Practice Address - Street 1:215 HAWKS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2708
Practice Address - Country:US
Practice Address - Phone:731-587-3454
Practice Address - Fax:731-587-3460
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005195363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341684Medicaid
TN3341684Medicare PIN
TN500026167Medicare PIN
R89516Medicare UPIN