Individual
KINNARI KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19415 DEERFIELD AVENUE, SUITE 112, LEESBURG, VA 20176-8470
(703) 724-1195
(703) 724-4495
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101271958
VA
208800000X
Urology Physician
MT210270
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952763435
—
VA
05
—
30016381720001
—
VA
Enumeration date
03/24/2016
Last updated
10/09/2023
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