Individual
MRS. KATHLEEN DACUK ROSE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1701 THOMSON DR, LYNCHBURG, VA 24501-1118
(434) 200-4010
(434) 200-7400
Mailing address
PO BOX 3017, LYNCHBURG, VA 24503-0017
(434) 200-4010
(434) 200-7400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001096751
VA
363L00000X
Nurse Practitioner
Primary
0024096751
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7782951
—
VA
Enumeration date
08/07/2006
Last updated
01/26/2016
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