Provider Demographics
NPI:1578322590
Name:KENNEDY, MEREDITH REBECCA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:REBECCA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ZANARK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1036
Mailing Address - Country:US
Mailing Address - Phone:803-381-8016
Mailing Address - Fax:
Practice Address - Street 1:107 ZANARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1036
Practice Address - Country:US
Practice Address - Phone:803-381-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97027163WM0102X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn