MEDICARE: TARA LYNN KENNEDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		OH
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1427839323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LYNN KENNEDY

Provider Business Mailing Address
First Line	:	920 COLUMBIA AVE APT 4
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-2261
Country	:	US
Telephone Number	:	330-642-5209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 MCKINLEY AVE # 2
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-1735
Country	:	US
Telephone Number	:	330-642-5209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	12/01/2023

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Directions to “ TARA LYNN KENNEDY ” Practice Location

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