Provider Demographics
NPI:1972574457
Name:KENNEDY, LYNETTE B (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-233-8603
Mailing Address - Fax:
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:STE. 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-233-8603
Practice Address - Fax:337-234-0341
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978035Medicaid
LA1978035Medicaid