Provider Demographics
NPI:1245397389
Name:KENNEDY, HEATHER PARKER (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:PARKER
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 E BOYSEN DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-3816
Mailing Address - Country:US
Mailing Address - Phone:501-428-3041
Mailing Address - Fax:
Practice Address - Street 1:480 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7808
Practice Address - Country:US
Practice Address - Phone:501-336-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 2892255A2300X
OK7632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer