Provider Demographics
NPI:1316302763
Name:KENNEY, TARA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JEAN
Last Name:KENNEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD DOVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3464
Mailing Address - Country:US
Mailing Address - Phone:603-516-9300
Mailing Address - Fax:603-335-9278
Practice Address - Street 1:25 OLD DOVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3464
Practice Address - Country:US
Practice Address - Phone:603-516-9300
Practice Address - Fax:603-335-9278
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07282123363L00000X
NH072821-23363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily