Healthcare Provider Details

I. General information

NPI: 1851237275
Provider Name (Legal Business Name): KENNEDY HER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4871 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4855 E CESAR CHAVEZ BLVD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-709-1980
  • Fax:
Mailing address:
  • Phone: 559-390-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: