1316799133 NPI number — KIRRA MCKELL KENNEDY REGISTERED NURSE

Table of content: KIRRA MCKELL KENNEDY REGISTERED NURSE (NPI 1316799133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316799133 NPI number — KIRRA MCKELL KENNEDY REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
KIRRA
Provider Middle Name:
MCKELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRAKE
Provider Other First Name:
KIRRA
Provider Other Middle Name:
MCKELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316799133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 TREE TOP LN APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA HILLS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-2846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-396-7549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-638-9100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  11742009-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)