Provider Demographics
NPI:1538056288
Name:KENNELL, MINDY ANN
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
Last Name:KENNELL
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 1:954 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9091
Mailing Address - Country:US
Mailing Address - Phone:330-310-4616
Mailing Address - Fax:
Practice Address - Street 1:954 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9091
Practice Address - Country:US
Practice Address - Phone:330-310-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker