Provider Demographics
NPI:1457380867
Name:KENNEDY, KAREN E (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1118 GULF BREEZE PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7800
Mailing Address - Country:US
Mailing Address - Phone:850-916-7766
Mailing Address - Fax:850-916-5144
Practice Address - Street 1:1118 GULF BREEZE PKWY
Practice Address - Street 2:STE 201
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7800
Practice Address - Country:US
Practice Address - Phone:850-916-7766
Practice Address - Fax:850-916-5144
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75325207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0701115OtherUNITED HEALTH CARE
FL59041231KENOtherBS ALABAMA
FL192082OtherCOVENTRY
FL7856118OtherAETNA
FL8087061OtherCIGNA
FL58754OtherBS FLORIDA
FL58754ZOtherMEDICARE PTAN
FL21149353644OtherBEECH STREET
FL8087061OtherCIGNA