Provider Demographics
NPI:1649598681
Name:KENNEDY, KINDRA MICHELLE (CPM, LDM, IBCLC)
Entity Type:Individual
Prefix:MISS
First Name:KINDRA
Middle Name:MICHELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CPM, LDM, IBCLC
Other - Prefix:MISS
Other - First Name:KINDRA
Other - Middle Name:MICHELLE
Other - Last Name:HERSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, LDM, IBCLC
Mailing Address - Street 1:21235 GARCIA RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8065
Mailing Address - Country:US
Mailing Address - Phone:541-480-8689
Mailing Address - Fax:541-205-4885
Practice Address - Street 1:21235 GARCIA RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8065
Practice Address - Country:US
Practice Address - Phone:541-480-8689
Practice Address - Fax:541-205-4885
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10156590176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500667822Medicaid