Provider Demographics
NPI:1871892612
Name:KENNEDY, ANNETTE T (FNP)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:T
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8072
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:400 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1014
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011029157363L00000X
IL209008783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner