Provider Demographics
NPI:1639748957
Name:KENNEDY, CHRISTY L (PHLEBOTOMY MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHLEBOTOMY MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 N PARKSMITH DR
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9501
Mailing Address - Country:US
Mailing Address - Phone:509-703-2202
Mailing Address - Fax:
Practice Address - Street 1:11320 N PARKSMITH DR
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9501
Practice Address - Country:US
Practice Address - Phone:509-703-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60346851207ZB0001X, 246Q00000X, 246QB0000X
WA603246QB0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60346851OtherMEDICAL ASST PHLEBOTOMY AND NATIONAL PHLEBOTOMY