Healthcare Provider Details

I. General information

NPI: 1447113311
Provider Name (Legal Business Name): MISS CHRISTIAN NICOLE KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 ALABASTER DR APT B20
DOTHAN AL
36301-9175
US

IV. Provider business mailing address

291 ALABASTER DR APT B20
DOTHAN AL
36301-9175
US

V. Phone/Fax

Practice location:
  • Phone: 334-648-8251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: