Healthcare Provider Details

I. General information

NPI: 1912588708
Provider Name (Legal Business Name): PAMELA GENISE KENNEDY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 N CENTRAL EXPY STE 210
DALLAS TX
75206-6556
US

IV. Provider business mailing address

4228 N CENTRAL EXPY STE 210
DALLAS TX
75206-6556
US

V. Phone/Fax

Practice location:
  • Phone: 214-366-4600
  • Fax: 214-366-4603
Mailing address:
  • Phone: 214-366-4600
  • Fax: 214-366-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number692174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: