Most Relevant Information
Provider Data
| NPI Number: | 1003301136 |
| Provider Name: | BETHANY JOY KENNEDY APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | APRN01804 |
Most Important Dates
| Enumeration Date: | 07/01/2018 |
| Last Updated: | 07/26/2018 |
Provider Practice Location
112 MANSFIELD AVE
WILLIMANTIC
CT
06226
Practice Location Phone/Fax
| Phone: | 8604569116 |
| Fax: |
Provider Mailing Location
112 MANSFIELD AVE
WILLIMANTIC
CT
062262045
Provider Mailing Phone/Fax
| Phone: | 8604569116 |
| Fax: |