Provider Demographics
NPI:1659576080
Name:KENNEDY, PATRICK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RICHARD
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
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 29001
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-9001
Mailing Address - Country:US
Mailing Address - Phone:501-622-1043
Mailing Address - Fax:501-622-2033
Practice Address - Street 1:300 WERNER ST.
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-9001
Practice Address - Country:US
Practice Address - Phone:501-622-1043
Practice Address - Fax:501-622-2033
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine