Provider Demographics
NPI:1164629002
Name:KENNEDY, RACHEL E (DO)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:E
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5750
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-355-9040
Mailing Address - Fax:256-355-9048
Practice Address - Street 1:2422 DANVILLE RD.
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9048
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-1083207Q00000X
NC2015-02452207Q00000X
OH34.012102207Q00000X
KY03953207Q00000X
VA0102204445207Q00000X
TN3036207Q00000X
SC39364207Q00000X
DCDO034561207Q00000X
NH17704207Q00000X
GA076649207Q00000X
FLOS14309207Q00000X
TXR0735207Q00000X
WV3140207Q00000X
ARE-10242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine