Healthcare Provider Details

I. General information

NPI: 1336965821
Provider Name (Legal Business Name): ALEXIS KENNEDY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 HARVARD ROAD
BEACHWOOD OH
44122-4412
US

IV. Provider business mailing address

26900 GEORGE ZEIGER DR APT 411
BEACHWOOD OH
44122-7612
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-2200
  • Fax: --
Mailing address:
  • Phone: 216-776-8850
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number527674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: