Provider Demographics
NPI:1386713550
Name:KENNEDY, LORI (RN MSN PNP (APN))
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN MSN PNP (APN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ROUTE 31
Mailing Address - Street 2:SUIT 500
Mailing Address - City:FLEMINGTEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-6650
Mailing Address - Fax:908-788-2578
Practice Address - Street 1:HUNTERDON DEVELOPMENTAL PEDIATRIC ASSOCIATES
Practice Address - Street 2:190 ROUTE 31 SUITE 500
Practice Address - City:FLEMINGTEN
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-6650
Practice Address - Fax:908-788-6650
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09088300363L00000X, 363LP0200X
NJ26 NO090088300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ13359Medicare UPIN
NJ078058Medicare ID - Type Unspecified