Provider Demographics
NPI:1649044363
Name:I KENNEDYD, SARMANN
Entity type:Individual
Prefix:DR
First Name:SARMANN
Middle Name:
Last Name:I KENNEDYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SPINNAKER WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4561
Mailing Address - Country:US
Mailing Address - Phone:469-515-1433
Mailing Address - Fax:
Practice Address - Street 1:1501 SPINNAKER WAY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4561
Practice Address - Country:US
Practice Address - Phone:469-515-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0227203747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant