Provider Demographics
NPI:1295510824
Name:KENNEDY, LISA ANN
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ANN
Last Name:KENNEDY
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 1:24966 REDDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-8881
Mailing Address - Country:US
Mailing Address - Phone:419-304-3092
Mailing Address - Fax:
Practice Address - Street 1:24966 REDDINGTON CT
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-8881
Practice Address - Country:US
Practice Address - Phone:419-297-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide