1821151978 NPI number — SHERYL ANN KENNEDY FNP-BC

Table of content: SHERYL ANN KENNEDY FNP-BC (NPI 1821151978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821151978 NPI number — SHERYL ANN KENNEDY FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
SHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEDY
Provider Other First Name:
SHERYL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821151978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 EASTBROOK BEND
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PEACH TREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-487-2273
Provider Business Mailing Address Fax Number:
770-487-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 EASTBROOK BEND
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PEACH TREE CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-487-2273
Provider Business Practice Location Address Fax Number:
770-487-2228
Provider Enumeration Date:
12/19/2006

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: 363LF0000X , with the licence number:  RN070145 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 942218511C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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