# KRISTY R. KENNEDY MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801142906
- **Authorized official:** DR. KRISTY KENNEDY (OWNER)
- **Authorized official phone:** (901) 674-2525

## Contact information

- **Practice address:** 1101 S COLLEGE RD, SUITE 202, LAFAYETTE, LA 70503-3038
- **Practice address phone:** (337) 235-6886
- **Mailing address:** 119 BEVERLY DR, LAFAYETTE, LA 70503-3105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD.204714 | LA | Yes |

## Other

- **Enumeration date:** 07/26/2012
- **Last updated:** 07/26/2012