Healthcare Provider Details

I. General information

NPI: 1609658830
Provider Name (Legal Business Name): TERKITA FORD KENNEDY MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 43RD ST
MERIDIAN MS
39305-3109
US

IV. Provider business mailing address

3805 43RD ST
MERIDIAN MS
39305-3109
US

V. Phone/Fax

Practice location:
  • Phone: 601-479-0531
  • Fax:
Mailing address:
  • Phone: 601-479-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number867399
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number906385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: