Provider Demographics
NPI:1184405201
Name:KENNEDY, ARLENE MELISSA (RN)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:MELISSA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ROSEWOOD ST APT 7N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6397
Mailing Address - Country:US
Mailing Address - Phone:917-696-1069
Mailing Address - Fax:
Practice Address - Street 1:700 ROSEWOOD ST APT 7N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6397
Practice Address - Country:US
Practice Address - Phone:917-696-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY834380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse