Healthcare Provider Details

I. General information

NPI: 1275458499
Provider Name (Legal Business Name): CARIN KENNARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72700 DINAH SHORE DR
PALM DESERT CA
92211-0818
US

IV. Provider business mailing address

35963 BERTAIN DR
PALM DESERT CA
92211-0887
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 607-795-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number515378-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: