Individual
CHERRY KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
301 N FIFTH ST, BOONEVILLE, MS 38829-2611
(662) 728-5894
Mailing address
301 N FIFTH ST, BOONEVILLE, MS 38829-2611
(662) 728-5894
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P124257
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770367
—
MS
Enumeration date
12/01/2006
Last updated
07/09/2007
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