Provider Demographics
NPI:1679873749
Name:KENNEDY, BRANDI JO
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:JO
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:JO
Other - Last Name:JORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3865
Mailing Address - Country:US
Mailing Address - Phone:402-681-3474
Mailing Address - Fax:
Practice Address - Street 1:504 S 18TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3865
Practice Address - Country:US
Practice Address - Phone:402-681-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator