Provider Demographics
NPI:1457399628
Name:KENNEDY, PATSY A (CRNP)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 UNIVERSITY BLVD N
Mailing Address - Street 2:HSB SUITE 1200
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-3053
Mailing Address - Country:US
Mailing Address - Phone:251-460-7681
Mailing Address - Fax:251-414-8227
Practice Address - Street 1:307 UNIVERSITY BLVD N
Practice Address - Street 2:HSB SUITE 1200
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-3053
Practice Address - Country:US
Practice Address - Phone:251-460-7681
Practice Address - Fax:251-414-8227
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-022627363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51514835OtherBLUE CROSS
AL891005180Medicaid
MS06988741Medicaid
LA1163392Medicaid
FL305364400Medicaid
AL51514836OtherBLUE CROSS
AL1457399628Medicaid
AL891005190Medicaid
AL51545852OtherBCBS-STUDENT HLTH
LA1163392Medicaid
FL305364400Medicaid
AL510I500136Medicare PIN