1457380867 NPI number — KAREN E KENNEDY M.D.

Table of content: KAREN E KENNEDY M.D. (NPI 1457380867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457380867 NPI number — KAREN E KENNEDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
KAREN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457380867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1118 GULF BREEZE PKWY
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
GULF BREEZE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32561-7800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-916-7766
Provider Business Mailing Address Fax Number:
850-916-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1118 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-916-7766
Provider Business Practice Location Address Fax Number:
850-916-5144
Provider Enumeration Date:
06/30/2006

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: 207VG0400X , with the licence number:  ME75325 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0701115 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59041231KEN . This is a "BS ALABAMA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 192082 . This is a "COVENTRY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7856118 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8087061 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 58754 . This is a "BS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 58754Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 21149353644 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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