Jennifer Marie Kennalley

Individual provider Active NPI Other Technician · Stockton, CA

NPI 1982247565 · NPPES record last updated Oct 25, 2019

Key facts

NPI
1982247565
Entity type
Individual (NPI type 1)
Primary specialty
Other Technician 247200000X
Practice address
2291 W March LN
Stockton, CA 95207-6652
Phone
(925) 408-8911
NPI assigned
Oct 25, 2019
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X Yes

Addresses

Primary practice location

2291 W March LN
Stockton, CA 95207-6652

Mailing address

2291 W March LN
Stockton, CA 95207-6652
Phone (925) 408-8911

Other providers in Stockton, CA

All providers in Stockton, CA · Other Technician in California

Sources for this page

Verify at the official NPI Registry.