Individual
JACKIE L KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BACHELORS, LPN
Contact information
Practice address
479 POLK ST # B4, TWIN FALLS, ID 83301-4850
(208) 339-1756
(855) 461-7240
Mailing address
479 POLK ST # B4, TWIN FALLS, ID 83301-4850
(208) 339-1756
(855) 461-7240
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10114
ID
Other
Enumeration date
10/16/2024
Last updated
10/16/2024
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