Provider Demographics
NPI:1427848407
Name:PRATT, KENNEDY
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:PRATT
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 1:22408 TOWNSHIP ROAD 275
Mailing Address - Street 2:
Mailing Address - City:ALVADA
Mailing Address - State:OH
Mailing Address - Zip Code:44802-9606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22408 TOWNSHIP ROAD 275
Practice Address - Street 2:
Practice Address - City:ALVADA
Practice Address - State:OH
Practice Address - Zip Code:44802-9606
Practice Address - Country:US
Practice Address - Phone:419-348-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program