Individual
JACOB H KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47747-0001
(812) 450-3405
(812) 450-3099
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01056432A
IN
207P00000X
Emergency Medicine Physician
04-49394
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000502241
BCBS - DEACONESS MARY ST
IN
01
—
000000502888
BCBS - DEACONESS GATEWAY
IN
05
—
200423240
—
IN
05
—
64130222
—
KY
01
—
P00397501
RR MEDICARE
IN
Enumeration date
12/29/2005
Last updated
12/12/2024
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