MRS. MARYANN KENNESON (NPI# 1790011062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790011062 |
| Entity Type | Individual |
| Full Name | MRS. MARYANN KENNESON |
| Credential | M.D. |
| Practice Address |
1895 Kingsley Ave Ste 903 Orange Park FL 32073-4410 |
| Mailing Address |
10881 San Jose Blvd Jacksonville FL 32223-6612 |
| Practice Telephone | 9046448353 |
| Practice Fax Number | 9046448289 |
| Mailing Telephone | 9042603022 |
| Mailing Fax Number | 9042603947 |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2018-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | ME92864 | FL | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 35098042 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0056336 | 05 | |
| FL | BCBS | 14N6L | 01 |
| FL | 006734700 | 05 |
| Street Address |
1895 KINGSLEY AVE STE 903 |
| City | ORANGE PARK |
| State | FL |
| Zip Code | 32073-4410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285182659 | Florida Pain Specialists Pllc | Skilled Nursing Facility | 1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 | 2016-09-14 |
| 1285983098 | Mary Ann Kenneson, M.d., LLC | Specialist | 1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 | 2012-09-07 |
| 1487954723 | Travis Randall Von Tobel | Surgery | 1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 | 2010-11-02 |
| 1922335389 | Jacksonville Ms and Neurology Center, P.a. | Psychiatry & Neurology | 1895 Kingsley Ave Ste 903, Orange Park, FL 32073-4410 | 2009-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891309423 | Kingsley Endoscopy Center LLC | Clinic/Center | 970 Kingsley Avenue, Orange Park, FL 32073 | 2020-09-01 |
| 1962028688 | Esra Sari | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue., Orange Park Medical Center, Orange Park, FL 32073 | 2020-06-18 |
| 1104441146 | Zeshan Tariq Malik | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue, Office of Graduate Medical Educa, Orange Park, FL 32073 | 2020-06-16 |
| 1902421894 | Ameer Hamza | Student in an Organized Health Care Education/Training Program | 2001, Kingsley Avenue Office of Graduate Medical Educat, Orange Park, FL 32073 | 2020-06-16 |
| 1497378103 | Fawad Ahmed Rashid | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue Office of Graduate Medical Educati, Orange Park, FL 32073 | 2020-05-28 |
| 1477174985 | Hannan Asghar | Student in an Organized Health Care Education/Training Program | Office of Graduate Medical Education 2001 Kingsley, Orange Park, FL 32073 | 2020-05-06 |
| 1902427156 | Emmanuel Iyanuloluwa Morakinyo | Student in an Organized Health Care Education/Training Program | 413 Deer View Avenue, 2001 Kingsley Ave, Orange Park, FL 32073 | 2020-04-29 |
| 1437799327 | Dalande Leger | Behavior Technician | 1563 Kingsley Ave Suite 103, Orange Park, FL 32073 | 2020-01-08 |
| 1215598313 | Mohammad Harisullah Khan | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Ave, Gme Office, Orange Park, FL 32073 | 2019-06-28 |
| 1558927970 | Preetha Kamath | Student in an Organized Health Care Education/Training Program | Orange Park Medical Center, 2001 Kingsley Ave, Orange Park, FL 32073 | 2019-05-10 |
| Find all providers in zip 32073 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962487033 | James Emmett Kaelin | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2005-12-13 |
| 1093174377 | Ackerman Cancer Center | Urology | 1895 Kingsley Ave, Suite 903, Orange Park, FL 32073-4466 | 2016-02-16 |
| 1932444254 | Florida Physician Specialists LLC | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2012-11-28 |
| 1720310733 | Integrated Community Oncology Network LLC | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2010-02-02 |
| 1407014814 | David Scott Bargnesi | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2008-06-02 |
| 1053468967 | Robert A. Marino | Urology | 2045 Professional Center Dr, Orange Park, FL 32073-4461 | 2007-01-04 |
| 1669552030 | Christopher Moore | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2006-10-17 |
| 1437245875 | Marc Hepner Blasser | Urology | 1715 Village Way, Orange Park, FL 32073 | 2006-10-05 |
| 1447235411 | Urology Assoc. of N.e. Florida | Urology | 1715 Village Way, Orange Park, FL 32073-5263 | 2005-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770193450 | Urotelemedicine LLC | Urology | 8669 Nw 36th St Ste 325, Doral, FL 33166-6698 | 2020-08-06 |
| 1700411618 | Ackerman Cancer Center, Pa | Urology | 159 North 3rd St, Macclenny, FL 32063-2103 | 2020-03-11 |
| 1043844483 | Jesse Aaron Ory | Urology | 5555 Ponce De Leon Blvd Fl 4, Coral Gables, FL 33146-2513 | 2020-02-25 |
| 1215591565 | Advent Health | Urology | 420 Celebration Ave, Celebration, FL 34747-4683 | 2019-04-23 |
| 1710442264 | Urologic Specialists of Central Florida Pllc | Urology | 575 S Wickham Rd Ste A, West Melbourne, FL 32904-1170 | 2019-02-08 |
| 1578028197 | Prody Urology, Pllc | Urology | 575 S Wickham Rd Ste B, West Melbourne, FL 32904-1170 | 2019-02-07 |
| 1366916843 | Dr. Carolyn Langford Urologic Solutions, LLC | Urology | 9400 Gladiolus Dr Ste 30, Fort Myers, FL 33908-9615 | 2019-01-17 |
| 1376016568 | Advanced Innovative Urology Pa | Urology | 4737 N Ocean Dr Ste 103, Lauderdale By The Sea, FL 33308-2920 | 2019-01-10 |
| 1306314281 | Urology Consultants of Boca Raton Pa | Urology | 825 Meadows Rd Ste 111, Boca Raton, FL 33486-2347 | 2018-11-08 |
| 1013490309 | Seetharam Bhat Kulthe Ramesh | Urology | 401 Celebration Pl Ste 200, Celebration, FL 34747-4971 | 2018-09-12 |
| Find all providers with the same taxonomy | ||||
| City | ORANGE PARK |
| Zip Code | 32073 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.