Provider Demographics
NPI:1790499622
Name:KENNEDY, KENDRA (PA)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 E 40TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1073
Mailing Address - Country:US
Mailing Address - Phone:331-999-4099
Mailing Address - Fax:
Practice Address - Street 1:244 E 40TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1073
Practice Address - Country:US
Practice Address - Phone:331-999-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program