Healthcare Provider Details

I. General information

NPI: 1891093704
Provider Name (Legal Business Name): PHIRIN LORTH KENNEDY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 MONTGOMERY RD
CINCINNATI OH
45242-4463
US

IV. Provider business mailing address

4685 FOREST AVE SUITE C
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-5600
  • Fax: 513-281-1981
Mailing address:
  • Phone: 513-853-4722
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.11965-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: