Provider Demographics
NPI:1609822386
Name:KENNEPP, LYNDA (PT, CWS-LANA)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:
Last Name:KENNEPP
Suffix:
Gender:F
Credentials:PT, CWS-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 CANAL PL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7536
Mailing Address - Country:US
Mailing Address - Phone:501-358-2675
Mailing Address - Fax:
Practice Address - Street 1:119 W H AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8733
Practice Address - Country:US
Practice Address - Phone:501-772-3224
Practice Address - Fax:501-772-7648
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT286225100000X
ARPT 2836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y511OtherBCBS
AR5Y511OtherBCBS