Provider Demographics
NPI:1003076852
Name:WARRETT KENNARD, M.D., P.A.
Entity Type:Organization
Organization Name:WARRETT KENNARD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:972-248-2426
Mailing Address - Street 1:5300 W PLANO PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4863
Mailing Address - Country:US
Mailing Address - Phone:972-248-2426
Mailing Address - Fax:972-248-2493
Practice Address - Street 1:5300 W PLANO PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4863
Practice Address - Country:US
Practice Address - Phone:972-248-2426
Practice Address - Fax:972-248-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098743002Medicaid
TX00H75UMedicare PIN