Provider Demographics
NPI:1972162816
Name:KENNY, BARRY
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:KENNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18122 66TH CT APT 202
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4171
Mailing Address - Country:US
Mailing Address - Phone:507-269-2130
Mailing Address - Fax:
Practice Address - Street 1:18122 66TH CT APT 202
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4171
Practice Address - Country:US
Practice Address - Phone:507-269-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program