Provider Demographics
NPI:1003944760
Name:KENNARD, KERRI JANINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:JANINE
Last Name:KENNARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-0576
Mailing Address - Country:US
Mailing Address - Phone:302-628-8740
Mailing Address - Fax:302-682-8760
Practice Address - Street 1:26876 SUSSEX HWY
Practice Address - Street 2:UNIT 2
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973
Practice Address - Country:US
Practice Address - Phone:302-628-8740
Practice Address - Fax:302-628-8760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000440103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037339Medicaid
DE100035675OtherDPCI PIN