Individual
KEVIN D KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1200 N STATE ST, SUITE 500, JACKSON, MS 39202-2000
(601) 352-2273
(601) 714-3415
Mailing address
1600 N STATE ST, SUITE 400, JACKSON, MS 39202-1689
(601) 944-1717
(601) 944-9780
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3757
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04139874
—
MS
01
—
P00410919
RR MEDICARE
MS
Enumeration date
06/04/2007
Last updated
09/03/2015
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