Healthcare Provider Details

I. General information

NPI: 1346690427
Provider Name (Legal Business Name): PAIGE MARIE KENNEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 LAKES BLVD
BREAUX BRIDGE LA
70517-3240
US

IV. Provider business mailing address

550 LAKES BLVD
BREAUX BRIDGE LA
70517-3240
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-9728
  • Fax:
Mailing address:
  • Phone: 337-761-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125.069451
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number330861
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: