Provider Demographics
NPI:1932142312
Name:KENNEDY, WILLIAM RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 S GARNETT
Mailing Address - Street 2:STE 101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129
Mailing Address - Country:US
Mailing Address - Phone:918-622-1994
Mailing Address - Fax:918-270-1958
Practice Address - Street 1:2227 S GARNETT
Practice Address - Street 2:STE 101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5115
Practice Address - Country:US
Practice Address - Phone:918-622-1994
Practice Address - Fax:918-270-1958
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2099208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100230280BMedicaid