Healthcare Provider Details

I. General information

NPI: 1932175734
Provider Name (Legal Business Name): DR. KAREN OLSEN KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-3510
US

IV. Provider business mailing address

637 WASHINGTON ST
DORCHESTER CENTER MA
02124-3510
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax:
Mailing address:
  • Phone: 617-825-9660
  • Fax: 617-288-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54035
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: