Healthcare Provider Details

I. General information

NPI: 1346705324
Provider Name (Legal Business Name): VALERIE ELIZABETH KENNEDY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 HOPI RD
SANTA FE NM
87505-2401
US

IV. Provider business mailing address

2023 HOPI RD
SANTA FE NM
87505-2401
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-7075
  • Fax:
Mailing address:
  • Phone: 505-670-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7877
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: