Provider Demographics
NPI:1851138242
Name:GIBBS, KENNEDY LEE (MEDICAL STUDENT MD)
Entity type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:LEE
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MEDICAL STUDENT MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:149 MADISON RIVER RD APT 107
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-6533
Mailing Address - Country:US
Mailing Address - Phone:270-790-1727
Mailing Address - Fax:
Practice Address - Street 1:780 ROSE STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program