Provider Demographics
NPI:1821151978
Name:KENNEDY, SHERYL ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:ANN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:8 EASTBROOK BEND
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEACH TREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269
Mailing Address - Country:US
Mailing Address - Phone:770-487-2273
Mailing Address - Fax:770-487-2228
Practice Address - Street 1:8 EASTBROOK BEND
Practice Address - Street 2:SUITE B
Practice Address - City:PEACH TREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:770-487-2273
Practice Address - Fax:770-487-2228
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA942218511CMedicaid
GA942218511CMedicaid
GA50BBGNJMedicare UPIN