Provider Demographics
NPI:1922341395
Name:KENNARD ISD
Entity Type:Organization
Organization Name:KENNARD ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-655-2161
Mailing Address - Street 1:304 HIGHWAY 7 E
Mailing Address - Street 2:
Mailing Address - City:KENNARD
Mailing Address - State:TX
Mailing Address - Zip Code:75847-5627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 7 E
Practice Address - Street 2:
Practice Address - City:KENNARD
Practice Address - State:TX
Practice Address - Zip Code:75847-5627
Practice Address - Country:US
Practice Address - Phone:936-655-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751456089Medicaid