Healthcare Provider Details

I. General information

NPI: 1750421095
Provider Name (Legal Business Name): SYLYNA G KENNEDY RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N FREDONIA ST
LONGVIEW TX
75601-6464
US

IV. Provider business mailing address

1107 E MARSHALL AVE
LONGVIEW TX
75601-5602
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2610
  • Fax: 903-758-7081
Mailing address:
  • Phone: 903-758-2610
  • Fax: 903-758-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAP118136
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP118136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: