Healthcare Provider Details

I. General information

NPI: 1528869526
Provider Name (Legal Business Name): KENNEDY VINSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BANCROFT ST
FAIRHOPE AL
36532-2444
US

IV. Provider business mailing address

100 N BANCROFT ST
FAIRHOPE AL
36532-2444
US

V. Phone/Fax

Practice location:
  • Phone: 251-517-1050
  • Fax: 251-517-1051
Mailing address:
  • Phone: 251-517-1050
  • Fax: 251-517-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-178901
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-178901
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: