Healthcare Provider Details

I. General information

NPI: 1710582234
Provider Name (Legal Business Name): KENNEY ORTHOPEDIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CHURCHMAN AVE STE 200
LOUISVILLE KY
40215-1186
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 502-805-1097
  • Fax: 502-586-7171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L SIMMONS
Title or Position: REGULATORY COMPLIANCE ANALYST III
Credential:
Phone: 859-594-2709