Kenneson, Maryann

Kenneson, Maryann is an individual health care provider with primary practice located at 1895 Kingsley Ave Ste 903 , Orange Park FL 32073-4410. She recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as her primary health care specialty. Kenneson, Maryann can be contacted via phone (904) 644-8353.

Contact Information

Primary practice address
1895 Kingsley Ave Ste 903 Orange Park FL 32073-4410
Phone: (904) 644-8353
Fax: (904) 644-8289
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 35098042 Ohio
Allopathic & Osteopathic Physicians / Urology 208800000X ME92864 Florida

Profile Details

NPI number 1790011062
LBN Legal business name Kenneson, Maryann
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2009
Last updated Feb 13th, 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 1790011062 NPPES
Ohio MEDICAID 0056336
Ohio Other 14N6L
Ohio MEDICAID 006734700

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