Healthcare Provider Details

I. General information

NPI: 1124899372
Provider Name (Legal Business Name): SARA MICHAEL KENNEDY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 1250
JACKSON MS
39216-4609
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-5955
  • Fax: 601-200-5939
Mailing address:
  • Phone: 601-200-5955
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907788
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number923661
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: