Provider Demographics
NPI:1326186131
Name:KENNEDY, SARAH LYNN (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
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 1:4401 PARK SPRINGS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1517
Mailing Address - Country:US
Mailing Address - Phone:817-960-9120
Mailing Address - Fax:817-466-7289
Practice Address - Street 1:4401 PARK SPRINGS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1517
Practice Address - Country:US
Practice Address - Phone:817-960-9120
Practice Address - Fax:817-466-7289
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6416207QS0010X, 390200000X
CO39020000X208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339171601Medicaid
TXP01447522OtherRAILROAD MEDICARE
TX8EQ081OtherBCBS
TX8EQ081OtherBCBS