Healthcare Provider Details

I. General information

NPI: 1013843879
Provider Name (Legal Business Name): KAITLYN KENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 MILLENNIUM PKWY STE 2-17
BRANDON FL
33511-3895
US

IV. Provider business mailing address

2138 ARROWGRASS DR UNIT 102
WESLEY CHAPEL FL
33544-4708
US

V. Phone/Fax

Practice location:
  • Phone: 407-520-2262
  • Fax:
Mailing address:
  • Phone: 407-520-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: