Individual
MRS. JACQUELINE MARIE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 DUTCHMANS LN, LOUISVILLE, KY 40207-4714
(502) 893-1277
Mailing address
20 WILSONVILLE HEIGHTS DR, FISHERVILLE, KY 40023-7521
(502) 492-9117
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1101629
KY
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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