Provider Demographics
NPI:1326391400
Name:KENNY, ELLEN REBEKAH
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:REBEKAH
Last Name:KENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3113
Mailing Address - Country:US
Mailing Address - Phone:615-444-8814
Mailing Address - Fax:615-489-4818
Practice Address - Street 1:1443 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3113
Practice Address - Country:US
Practice Address - Phone:615-444-8814
Practice Address - Fax:615-489-4818
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist