Provider Demographics
NPI:1346205721
Name:KENNEDY, KAREN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LESLIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 N 32ND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3927
Mailing Address - Country:US
Mailing Address - Phone:602-866-1974
Mailing Address - Fax:602-375-3949
Practice Address - Street 1:15420 N 32ND DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3927
Practice Address - Country:US
Practice Address - Phone:602-866-1974
Practice Address - Fax:602-375-3949
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26167208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ131459Medicaid