Provider Demographics
NPI:1891237541
Name:KENNEDY, RACHEL N (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 W LAYTON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2600
Mailing Address - Country:US
Mailing Address - Phone:414-242-5468
Mailing Address - Fax:888-724-0875
Practice Address - Street 1:8800 VIRGINIA PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7109
Practice Address - Country:US
Practice Address - Phone:219-736-1310
Practice Address - Fax:219-756-3562
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9337519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN710008813AOtherINDIANA STATE LICENSE
IN300028727Medicaid