Healthcare Provider Details

I. General information

NPI: 1578322590
Provider Name (Legal Business Name): MEREDITH REBECCA KENNEDY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ZANARK CT
COLUMBIA SC
29212-1036
US

IV. Provider business mailing address

107 ZANARK CT
COLUMBIA SC
29212-1036
US

V. Phone/Fax

Practice location:
  • Phone: 803-381-8016
  • Fax:
Mailing address:
  • Phone: 803-381-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number97027
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number97027
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: