Provider Demographics
NPI:1225477607
Name:KENNARD, JESSICA (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KENNARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WINDERLEY PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7267
Mailing Address - Country:US
Mailing Address - Phone:407-303-0500
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 786
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4651
Practice Address - Country:US
Practice Address - Phone:407-303-2422
Practice Address - Fax:407-303-2435
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14414207VX0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology