Provider Demographics
NPI:1407995475
Name:KENNY, CATHERINE E (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:KENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:701
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-487-2160
Mailing Address - Fax:941-487-2168
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-566-3220
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-245972084N0400X
MO20040189212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207588906Medicaid
MO207588906Medicaid
MOD24475Medicare UPIN