Individual
SHANE W KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
L6086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10012357
AMERIGROUP
—
05
—
158632301
—
TX
01
—
1634611
UNISYS
—
01
—
7724474
AETNA
—
01
—
8J5430
BCBS OF TX
TX
01
—
P00040101
MEDICARE RAILROAD
—
Enumeration date
06/15/2006
Last updated
03/18/2021
Update your record
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