Provider Demographics
NPI:1649573346
Name:KENNEDY, LEIGHTON (PMHNP, BC)
Entity Type:Individual
Prefix:MR
First Name:LEIGHTON
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials: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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21150-0212
Mailing Address - Country:US
Mailing Address - Phone:202-355-8587
Mailing Address - Fax:202-478-2919
Practice Address - Street 1:8101 SANDY SPRING RD STE 250
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3527
Practice Address - Country:US
Practice Address - Phone:202-355-8587
Practice Address - Fax:202-478-2919
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN215628363LP0808X
VA0024183634363LP0808X
MN5773363LP0808X
MDR203481363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health