Provider Demographics
NPI:1689315848
Name:KENNEDY, BORDEN
Entity Type:Individual
Prefix:MR
First Name:BORDEN
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HOSPITAL RD APT 11
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2153
Mailing Address - Country:US
Mailing Address - Phone:765-427-3523
Mailing Address - Fax:
Practice Address - Street 1:820 HOSPITAL RD APT 11
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2153
Practice Address - Country:US
Practice Address - Phone:765-427-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
U44485355OtherCIGNA