Healthcare Provider Details

I. General information

NPI: 1356194773
Provider Name (Legal Business Name): HAILEY ANN KENNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3423
US

IV. Provider business mailing address

3825 GRANTS LN
BIRMINGHAM AL
35210-5511
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-7050
  • Fax:
Mailing address:
  • Phone: 251-751-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-185248
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: