Provider Demographics
NPI:1407841463
Name:KENNEDY, WENDY K (DPM)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DPM
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 3402
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-0402
Mailing Address - Country:US
Mailing Address - Phone:812-234-4243
Mailing Address - Fax:812-478-3663
Practice Address - Street 1:1024 S 6TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-5015
Practice Address - Country:US
Practice Address - Phone:812-232-3338
Practice Address - Fax:812-234-8828
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000900A207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81113Medicare UPIN