Individual
KENEDI ELLEN ELIZABETH DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
751 W 9TH ST, JASPER, IN 47546-2609
(812) 996-7474
Mailing address
751 W 9TH ST, JASPER, IN 47546-2609
(812) 996-7474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01096665A
IN
Other
Enumeration date
04/15/2022
Last updated
07/10/2025
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