Individual
MRS. MICHELLE LYNN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
51 N ELM ST, WATERBURY, CT 06702-1511
(203) 574-4000
(203) 574-4003
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
16084
CA
363LF0000X
Family Nurse Practitioner
Primary
3620
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
02/09/2007
Last updated
11/01/2011
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