Healthcare Provider Details

I. General information

NPI: 1093527012
Provider Name (Legal Business Name): DIANA LEWIS KENNEDY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CANAL ST
NEW ORLEANS LA
70119-6535
US

IV. Provider business mailing address

1509 ADMIRAL NELSON DR
SLIDELL LA
70461-4506
US

V. Phone/Fax

Practice location:
  • Phone: 800-935-8387
  • Fax:
Mailing address:
  • Phone: 504-224-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberRN158151
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: