Healthcare Provider Details

I. General information

NPI: 1437049376
Provider Name (Legal Business Name): JORDAN LYN KENNEDY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR BLDG 1402
DAVIE FL
33328-2018
US

IV. Provider business mailing address

PO BOX 290370
DAVIE FL
33329-0370
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4235
  • Fax: 954-262-3904
Mailing address:
  • Phone: 954-262-4397
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: