Provider Demographics
NPI:1043380702
Name:KENNEDY, WHITNEY S (MD)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:S
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 TEJON ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1813
Mailing Address - Country:US
Mailing Address - Phone:303-381-3700
Mailing Address - Fax:303-477-4118
Practice Address - Street 1:4104 TEJON ST.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1813
Practice Address - Country:US
Practice Address - Phone:303-381-3700
Practice Address - Fax:303-477-4118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79126006Medicaid
CO79126006Medicaid