Healthcare Provider Details

I. General information

NPI: 1912817636
Provider Name (Legal Business Name): DESTINY D KENNERSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 DIJON DR
BATON ROUGE LA
70808-4311
US

IV. Provider business mailing address

10231 THE GROVE BLVD UNIT 17
BATON ROUGE LA
70836-6454
US

V. Phone/Fax

Practice location:
  • Phone: 225-256-3828
  • Fax: 225-256-3828
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: