Provider Demographics
NPI:1275642084
Name:KENNEDY, LESLEY H (CNM)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:H
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3835
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:10521 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9509
Practice Address - Country:US
Practice Address - Phone:206-296-4990
Practice Address - Fax:206-205-5142
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00089640163W00000X
WAAP30001702367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604760Medicaid
WA9604760Medicaid
WA9604760Medicaid
WAAB38285Medicare ID - Type UnspecifiedHIPT
WAR78700Medicare UPIN
WAAB38288Medicare ID - Type UnspecifiedMFFC
WAAB38297Medicare ID - Type UnspecifiedRBMC
WAAB38300Medicare ID - Type UnspecifiedRNPK