Provider Demographics
NPI:1578980264
Name:KENNEDY, VICKI (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-2008
Mailing Address - Country:US
Mailing Address - Phone:605-428-5291
Mailing Address - Fax:
Practice Address - Street 1:808 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-2008
Practice Address - Country:US
Practice Address - Phone:605-428-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDP006343311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home