Provider Demographics
NPI:1235414996
Name:KENNEDY, TONYA LYN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:LYN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29443 STATE ROUTE 328
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-8934
Mailing Address - Country:US
Mailing Address - Phone:740-541-2084
Mailing Address - Fax:740-596-2632
Practice Address - Street 1:29443 STATE ROUTE 328
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-8934
Practice Address - Country:US
Practice Address - Phone:740-541-2084
Practice Address - Fax:740-596-2632
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091947164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse