Provider Demographics
NPI:1194199331
Name:KENNY, MEGAN (APRN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 OLEANDER MILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7138
Mailing Address - Country:US
Mailing Address - Phone:708-955-5354
Mailing Address - Fax:
Practice Address - Street 1:2093 PHILADELPHIA PIKE # 9898
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2424
Practice Address - Country:US
Practice Address - Phone:415-651-3458
Practice Address - Fax:630-646-6542
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274934163W00000X, 363LP0808X
CT208392163W00000X
SC25964A163W00000X
FLAPRN11022297163WP0808X
IL041389955163WP0808X
CT12250363LP0808X
OK216804363LP0808X
IAG178539363LP0808X
RIAPRN03990363LP0808X
SDCP003150363LP0808X
SC25964RX363LP0808X
IL209013659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health