Provider Demographics
NPI:1609089143
Name:KENNEDY, JENNIFER (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:GROUND RAVDIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-6698
Mailing Address - Fax:215-662-3953
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:GROUND SILVERSTEIN BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4283
Practice Address - Country:US
Practice Address - Phone:215-662-6698
Practice Address - Fax:215-662-3953
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE554208D00000X, 207P00000X
PAOS020833207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice