Provider Demographics
NPI:1477126688
Name:KENNEDY, MELISSA DANIELLE (CPM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-450 OPO PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1880
Mailing Address - Country:US
Mailing Address - Phone:571-232-6248
Mailing Address - Fax:
Practice Address - Street 1:95-450 OPO PL
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1880
Practice Address - Country:US
Practice Address - Phone:571-232-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X, 174N00000X
HICPM25110882176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN