Individual
LAURA CANCILLA KENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 CAVALRY DR., STE 102, FLORENCE, KY 41042
(859) 817-9772
(859) 817-9885
Mailing address
1515 CAVALRY DR., STE 102, FLORENCE, KY 41042
(859) 817-9772
(859) 817-9885
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-086281
OH
207RA0401X
Addiction Medicine (Internal Medicine) Physician
35.086281
OH
207RA0401X
Addiction Medicine (Internal Medicine) Physician
43946
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200523050
—
IN
05
—
2594581
—
OH
05
—
6410106600
—
KY
01
—
P00224928
RAIL ROAD MEDICARE
OH
Enumeration date
04/26/2006
Last updated
03/08/2021
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