Provider Demographics
NPI:1992376453
Name:KENNINGTON, BAILEY RENATE
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:RENATE
Last Name:KENNINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 COUNTY ROAD 610
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-5230
Mailing Address - Country:US
Mailing Address - Phone:334-389-1014
Mailing Address - Fax:
Practice Address - Street 1:84 COUNTY ROAD 610
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-5230
Practice Address - Country:US
Practice Address - Phone:334-389-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL243779Medicaid