Provider Demographics
NPI:1851714273
Name:KENNEDY, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1032
Mailing Address - Country:US
Mailing Address - Phone:502-349-6057
Mailing Address - Fax:502-349-1089
Practice Address - Street 1:331 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1032
Practice Address - Country:US
Practice Address - Phone:502-349-6057
Practice Address - Fax:502-349-1089
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor