Provider Demographics
NPI:1942489323
Name:TAYLOR-KENNEDY, LISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:TAYLOR-KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14902 PRESTON RD STE 404-745
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9191
Mailing Address - Country:US
Mailing Address - Phone:214-443-1240
Mailing Address - Fax:
Practice Address - Street 1:14902 PRESTON RD STE 404-745
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9191
Practice Address - Country:US
Practice Address - Phone:214-443-1240
Practice Address - Fax:214-443-1240
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2989207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0427247-04Medicaid
TX1699786210OtherNPI
TX8AM081OtherBCBS
TX0427247-05Medicaid
TX0427247-05Medicaid
TX0427247-04Medicaid
TX8K6149Medicare PIN