Provider Demographics
NPI:1871461996
Name:KENNEDY, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:ITMANN
Mailing Address - State:WV
Mailing Address - Zip Code:24847-0143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 3RD HILL STREET
Practice Address - Street 2:
Practice Address - City:ITMANN
Practice Address - State:WV
Practice Address - Zip Code:24847
Practice Address - Country:US
Practice Address - Phone:681-368-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide