Healthcare Provider Details

I. General information

NPI: 1932562725
Provider Name (Legal Business Name): KATHRYN L KENNEDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

IV. Provider business mailing address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax: 402-420-6969
Mailing address:
  • Phone: 402-420-7000
  • Fax: 402-420-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD471266
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberE-16730
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number36743
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: