Healthcare Provider Details

I. General information

NPI: 1477126688
Provider Name (Legal Business Name): MELISSA DANIELLE KENNEDY CPM, LM, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-450 OPO PL
MILILANI HI
96789-1880
US

IV. Provider business mailing address

95-450 OPO PL
MILILANI HI
96789-1880
US

V. Phone/Fax

Practice location:
  • Phone: 571-232-6248
  • Fax:
Mailing address:
  • Phone: 571-232-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW-43
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: