Individual
DR. AGNES KENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1694 W LOGANSPORT RD, PERU, IN 46970-3149
(765) 472-2812
(765) 472-2970
Mailing address
1694 W LOGANSPORT RD, PERU, IN 46970-3149
(765) 472-2812
(765) 472-2970
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01031072A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000752605
ANTHEM
IN
05
—
1002555200
—
IN
01
—
P01011306
RAILROAD
IN
Enumeration date
04/18/2006
Last updated
08/15/2016
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