Healthcare Provider Details

I. General information

NPI: 1467249474
Provider Name (Legal Business Name): KENNEDY'S PROMISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 PUETT COVE RD
MARBLE NC
28905-9214
US

IV. Provider business mailing address

498 PUETT COVE RD
MARBLE NC
28905-9214
US

V. Phone/Fax

Practice location:
  • Phone: 828-361-6987
  • Fax: 828-895-0041
Mailing address:
  • Phone: 828-361-6987
  • Fax: 828-895-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BREANNA JENNINGS
Title or Position: OWNER
Credential:
Phone: 828-361-6987