Provider Demographics
NPI:1609658830
Name:KENNEDY, TERKITA FORD (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TERKITA
Middle Name:FORD
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-3109
Mailing Address - Country:US
Mailing Address - Phone:601-479-0531
Mailing Address - Fax:
Practice Address - Street 1:3805 43RD ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-3109
Practice Address - Country:US
Practice Address - Phone:601-479-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS867399163WP0808X
MS906385163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health