Provider Demographics
NPI:1215305453
Name:KENNY, LUISA JEANNE (CRNP, AGPCNP-BC, CNS)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:JEANNE
Last Name:KENNY
Suffix:
Gender:F
Credentials:CRNP, AGPCNP-BC, CNS
Other - Prefix:
Other - First Name:LUISA
Other - Middle Name:JEANNE
Other - Last Name:GRIJALVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, AGPCNP-BC, CNS
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017552363LA2200X
CANP95002813363LG0600X, 363LP2300X
CA95002813363LP2300X
CACNS4339364S00000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care