Healthcare Provider Details

I. General information

NPI: 1639084650
Provider Name (Legal Business Name): HAYLEY KENEPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KING GEORGE BLVD
SAVANNAH GA
31419-9547
US

IV. Provider business mailing address

PO BOX 253
SKILLMAN NJ
08558-0253
US

V. Phone/Fax

Practice location:
  • Phone: 912-785-9027
  • Fax: 912-525-2890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2839826
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: