Individual provider · Type 1 NPI

Miranda Kennedy

Family Nurse Practitioner · Rockford, IL

NPI number 1902266992 Active

Practice location

2222 E State St Ste 209
Rockford, IL 61104-1572

Mailing address

5405 N Knoxville Ave
Peoria, IL 61614-5016

Other practice locations

  • 5405 N Knoxville Ave, Peoria, IL 61614-5016 · (309) 691-4410

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse 163W00000X041398969 (IL)
Family Nurse Practitioner Primary 363LF0000X209014174 (IL)

Family Nurse Practitioner: Definition to come...

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About NPI 1902266992

Miranda Kennedy's National Provider Identifier is 1902266992, issued on Mar 3, 2016. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Rockford, IL. The record was last updated on Apr 9, 2019.