Provider Demographics
NPI:1437697638
Name:KENNEDY, PATRICIA A (RDN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SUMMERWIND LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1864
Mailing Address - Country:US
Mailing Address - Phone:215-764-0963
Mailing Address - Fax:
Practice Address - Street 1:267 SUMMERWIND LN
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1864
Practice Address - Country:US
Practice Address - Phone:215-764-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000815133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered