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Individual
CRYSTAL NICOLE KENNEDY
Active
Individual
CRYSTAL NICOLE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71006117A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
71006117A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902267057
ANTHEM PTAN
IN
05
—
201350820
—
IN
01
—
Q00659366
RAILROAD PTAN
IN
Enumeration date
03/17/2016
Last updated
10/17/2024
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