Kennedy, Diane Marie

Kennedy, Diane Marie is an individual health care provider with primary practice located at 2185 W Grant Line Rd , Tracy CA 95377-7309. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Kennedy, Diane Marie can be contacted via phone (209) 839-6231.

Contact Information

Primary practice address
2185 W Grant Line Rd Tracy CA 95377-7309
Phone: (209) 839-6231
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 95006559 California

Profile Details

NPI number 1972013597
LBN Legal business name Kennedy, Diane Marie
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2017
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972013597 NPPES
California MEDICAID 941105628

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