Provider Demographics
NPI:1932539376
Name:KENNEDY, CANDICE L (MS, DPM)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:L
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 OLD KINGS RD S STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4845
Mailing Address - Country:US
Mailing Address - Phone:904-323-0954
Mailing Address - Fax:904-212-0455
Practice Address - Street 1:8613 OLD KINGS RD S STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217
Practice Address - Country:US
Practice Address - Phone:904-323-0954
Practice Address - Fax:904-660-2125
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist