Healthcare Provider Details

I. General information

NPI: 1457399628
Provider Name (Legal Business Name): PATSY A. KENNEDY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 UNIVERSITY BLVD N HSB SUITE 1200
MOBILE AL
36688-3053
US

IV. Provider business mailing address

307 UNIVERSITY BLVD N HSB SUITE 1200
MOBILE AL
36688-3053
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-7681
  • Fax: 251-414-8227
Mailing address:
  • Phone: 251-460-7681
  • Fax: 251-414-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-022627
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-022627
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: