Individual
JUDITH L KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11123 PARKVIEW PLAZA DR., SUITE 101, FORT WAYNE, IN 46845
(260) 425-6650
(260) 425-6649
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01064765B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000620977
ANTHEM
IN
05
—
200947960
—
IN
01
—
3013287
OH MEDICAID
IN
01
—
P00907654
R.R. MEDICARE
IN
Enumeration date
02/05/2008
Last updated
04/04/2023
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