Provider Demographics
NPI:1477126688
Name:KENNEDY, MELISSA DANIELLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 TURTLE CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1702
Mailing Address - Country:US
Mailing Address - Phone:571-232-6248
Mailing Address - Fax:
Practice Address - Street 1:13810 TURTLE CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1702
Practice Address - Country:US
Practice Address - Phone:571-232-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program