Healthcare Provider Details

I. General information

NPI: 1396670147
Provider Name (Legal Business Name): KINNEDI GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 KARL RD
COLUMBUS OH
43229-5147
US

IV. Provider business mailing address

6037 CLEVELAND AVE
COLUMBUS OH
43231-2256
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-2588
  • Fax:
Mailing address:
  • Phone: 614-267-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: