Healthcare Provider Details

I. General information

NPI: 1194743880
Provider Name (Legal Business Name): NANCY ARLENE KENNEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 STATE ROAD 129 S
BATESVILLE IN
47006-7628
US

IV. Provider business mailing address

PO BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-6400
  • Fax: 812-934-6330
Mailing address:
  • Phone: 812-933-5441
  • Fax: 812-933-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01037704A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: