Provider Demographics
NPI:1760080014
Name:KENNEDY, STEPHANIE (DVM, DACVIM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DVM, DACVIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E SONTERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4058
Mailing Address - Country:US
Mailing Address - Phone:210-930-8383
Mailing Address - Fax:210-930-8040
Practice Address - Street 1:503 E SONTERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4058
Practice Address - Country:US
Practice Address - Phone:210-930-8383
Practice Address - Fax:210-930-8040
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine