Provider Demographics
NPI:1518137843
Name:KENNEDY, KRISTIN DIETZ (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DIETZ
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7766 EWING BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7537
Mailing Address - Country:US
Mailing Address - Phone:859-283-1033
Mailing Address - Fax:
Practice Address - Street 1:7766 EWING BLVD
Practice Address - Street 2:STE 100
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7537
Practice Address - Country:US
Practice Address - Phone:859-283-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner