Mary Ann Kenneson, M.D., LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME92864 Issued in FL

Legal business name

MARY ANN KENNESON, M.D., LLC

Practice address

1895 Kingsley Ave Ste 903
Orange Park, FL 32073-4410

Phone

(904) 644-8353

Fax

(904) 644-8289

NPI assigned

Sep 7, 2012

Last updated

Mar 2, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Maryann Kenneson, MDNPI 1790011062

Title

President

Phone

(859) 421-3759

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maryann Kenneson, M.D.

  • Urology Physician
  • Orange Park, FL
  • NPI 1790011062
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1285983098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 KINGSLEY AVE STE 903",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734410",
            "telephone_number": "904-644-8353",
            "fax_number": "904-644-8289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 KINGSLEY AVE STE 903",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734410",
            "telephone_number": "904-644-8353",
            "fax_number": "904-644-8289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ANN KENNESON, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "KENNESON",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-421-3759",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME92864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kourtney Martin, CNM
• Elaine S. Martinez, DMD
• Suzanne L Martinez, MD
• Vanessa Martinez, MS
• Harry D. Marty Vigo, M.D.
• Mary E. Schmieder DO. Facep, Inc
• Sharlind S Massey
• Master Your Journey Wellness Center, LLC
• Peter Masterson, APRN
• Keziah E Matheson-Lindnal, L.P.N.

• Specialist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.