Individual
KENNEDY ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 E 45TH ST, SHAWNEE, OK 74804-2202
(405) 273-1170
(405) 275-5132
Mailing address
7 HICKORY DR, SHAWNEE, OK 74804-9433
(405) 273-1170
(405) 275-5132
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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