Provider Demographics
NPI:1487682365
Name:KENNEDY, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 458W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0000
Practice Address - Country:US
Practice Address - Phone:423-230-6900
Practice Address - Fax:423-844-4987
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17737207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621112685OtherUNITED HEALTH CARE
TN110099852Medicaid
KY64925613Medicaid
VA6081665Medicaid
TN3025880Medicaid
TN3025884Medicare ID - Type UnspecifiedCIGNA
KY64925613Medicaid