Provider Demographics
NPI:1467206151
Name:KENNINGTON, MARTHA DAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:DAWN
Last Name:KENNINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4699
Mailing Address - Country:US
Mailing Address - Phone:864-577-7780
Mailing Address - Fax:864-577-7629
Practice Address - Street 1:355 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4699
Practice Address - Country:US
Practice Address - Phone:864-577-7780
Practice Address - Fax:864-577-7629
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse