Provider Demographics
NPI:1376370981
Name:YANCY, KENNEDY CHANELLE
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:CHANELLE
Last Name:YANCY
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 1:925 E DIXON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-4115
Mailing Address - Country:US
Mailing Address - Phone:501-234-2000
Mailing Address - Fax:
Practice Address - Street 1:1000 CARNAHAN DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6872
Practice Address - Country:US
Practice Address - Phone:501-851-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant