Provider Demographics
NPI:1033448295
Name:COLLEEN I. KENNEDY, MD, PA
Entity Type:Organization
Organization Name:COLLEEN I. KENNEDY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-775-1356
Mailing Address - Street 1:4450 TUBBS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6308
Mailing Address - Country:US
Mailing Address - Phone:214-775-1356
Mailing Address - Fax:
Practice Address - Street 1:4450 TUBBS RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6308
Practice Address - Country:US
Practice Address - Phone:214-775-1356
Practice Address - Fax:214-613-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty