Individual
MR. MICHAEL DEE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
3120 SOUTHRIDE LANE, BONIFAY, FL 32425
(850) 547-4440
(850) 547-4441
Mailing address
1360 BRICKYARD RD, CHIPLEY, FL 32428-6303
(850) 638-1610
(850) 415-8187
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
ARNP9206905
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000636200
—
FL
01
—
ARNP9206905
FL LICENSE
FL
01
—
Y129U
BCBS
—
Enumeration date
08/25/2008
Last updated
08/14/2024
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