Provider Demographics
NPI:1699737130
Name:KENNEDY, DONNA L (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 447
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416
Mailing Address - Country:US
Mailing Address - Phone:207-469-7371
Mailing Address - Fax:
Practice Address - Street 1:110 BROADWAY
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-7371
Practice Address - Fax:207-469-7306
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER045246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES26045Medicare UPIN
MEKE NP3538Medicare ID - Type UnspecifiedMEDICARE B