Healthcare Provider Details

I. General information

NPI: 1134053929
Provider Name (Legal Business Name): KENNEDY MORGAN EASTERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4603 TIMBERWALK CT
LA GRANGE KY
40031-6746
US

IV. Provider business mailing address

410 JASON DR APT E12
RICHMOND KY
40475-2779
US

V. Phone/Fax

Practice location:
  • Phone: 703-575-8129
  • Fax:
Mailing address:
  • Phone: 859-779-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number300361
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: