Healthcare Provider Details

I. General information

NPI: 1316872609
Provider Name (Legal Business Name): KENNEDI N MCCLAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 SCHOLL RD
MANSFIELD OH
44907-1571
US

IV. Provider business mailing address

325 TAYLOR RD
MANSFIELD OH
44903-1844
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-1717
  • Fax:
Mailing address:
  • Phone: 740-281-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042755
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: