Lisa Ann Kennelly, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

95009012 Issued in CA

Practice address

16931 Bayou LN
Fontana, CA 92336-2199

Phone

(909) 921-3072

NPI assigned

Jul 9, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1508352972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16931 BAYOU LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362199",
            "telephone_number": "909-921-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16931 BAYOU LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362199",
            "telephone_number": "909-921-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95009012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kamal Kejriwal, MD
• Kadette Kelly, CRNA
• Sumira Kemp, NP
• Banchiamlak Kendrix
• Madalyn Kae Kennedy
• Sharon Kennon, LCSW
• Rosalind Kerley, LCSW
• Kyle Kerner
• Jaime Diane Kerr-Lewis, P.T.
• Garrett James Kerwin, CRNA

• Adult Health Nurse Practitioner in Fontana, CA
• Providers in Fontana, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.