Individual
MRS. KATHRYN ANN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1400 N RITTER AVE, SUITE 520, INDIANAPOLIS, IN 46219-3052
(317) 355-1234
(317) 355-1505
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28168118A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004438A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201167410
—
IN
01
—
P01227937
RR MEDICARE PTAN
IN
Enumeration date
05/17/2013
Last updated
06/11/2021
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