Provider Demographics
NPI:1770355588
Name:ADAMS, KENNEDY K
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:K
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENNEDY
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5732 E 25TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5104
Mailing Address - Country:US
Mailing Address - Phone:520-440-4538
Mailing Address - Fax:
Practice Address - Street 1:5732 E 25TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-5104
Practice Address - Country:US
Practice Address - Phone:520-440-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program