Provider Demographics
NPI:1881920080
Name:SHARP, KENNEDY (MS, LAC)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SELBY AVENUE
Mailing Address - Street 2:G2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-224-6678
Mailing Address - Fax:
Practice Address - Street 1:400 SELBY AVENUE
Practice Address - Street 2:G2
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4508
Practice Address - Country:US
Practice Address - Phone:651-224-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist