Provider Demographics
NPI:1528573573
Name:KENNEDY, VICTORIA KING (CRNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KING
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11448 ALABASTER DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-3408
Mailing Address - Country:US
Mailing Address - Phone:251-229-2233
Mailing Address - Fax:251-257-5043
Practice Address - Street 1:11448 ALABASTER DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-3408
Practice Address - Country:US
Practice Address - Phone:251-229-2233
Practice Address - Fax:251-257-5043
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129596207Q00000X, 363LF0000X
FLAPRN11014337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMK6232730OtherDEA