Provider Demographics
NPI:1275676942
Name:KIMBERLY B. KENNEDY, INC.
Entity Type:Organization
Organization Name:KIMBERLY B. KENNEDY, INC.
Other - Org Name:A WOMAN'S TOUCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:903-593-1590
Mailing Address - Street 1:1733 TROUP HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5869
Mailing Address - Country:US
Mailing Address - Phone:903-593-1590
Mailing Address - Fax:903-593-4689
Practice Address - Street 1:1733 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5869
Practice Address - Country:US
Practice Address - Phone:903-593-1590
Practice Address - Fax:903-593-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530495OtherBLUE CROSS BLUE SHIELD
TX530495OtherBLUE CROSS BLUE SHIELD