Healthcare Provider Details

I. General information

NPI: 1710817945
Provider Name (Legal Business Name): KENNEDY SHAY HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENNEDY SHAY HIGGINS

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23641 WAR EAGLE BLACKTOP RD
SPRINGDALE AR
72764-9750
US

IV. Provider business mailing address

23641 WAR EAGLE BLACKTOP RD
SPRINGDALE AR
72764-9750
US

V. Phone/Fax

Practice location:
  • Phone: 316-755-8996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: