Provider Demographics
NPI:1467836825
Name:KENNEDY, SABRINA J (CNA)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MS
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1220 CARBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8152
Mailing Address - Country:US
Mailing Address - Phone:254-229-2865
Mailing Address - Fax:469-575-0178
Practice Address - Street 1:1220 CARBERRY ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-8152
Practice Address - Country:US
Practice Address - Phone:254-229-2865
Practice Address - Fax:469-575-0178
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX517279Medicaid