Provider Demographics
NPI:1942672241
Name:KENNEDY, MECHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:MECHELLE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 HIGHWAY 151 STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4499
Mailing Address - Country:US
Mailing Address - Phone:210-682-9434
Mailing Address - Fax:
Practice Address - Street 1:11212 HIGHWAY 151 STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4499
Practice Address - Country:US
Practice Address - Phone:210-682-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily