Provider Demographics
NPI:1417345729
Name:KENNEDY, MADELYN (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W GROVE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1882
Mailing Address - Country:US
Mailing Address - Phone:972-932-1319
Mailing Address - Fax:972-932-1396
Practice Address - Street 1:1011 W GROVE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1882
Practice Address - Country:US
Practice Address - Phone:972-932-1319
Practice Address - Fax:972-932-1396
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX863459163W00000X
TXAP127205363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse