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General NPI Number Information
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NPI Number | 1275676942
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Entity Type | Organization
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Legal Business Name | KIMBERLY B. KENNEDY, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1733 TROUP HWY
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City | TYLER
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State | TX
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Zip | 75701-5869
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Country | US
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Telephone | 903-593-1590
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Fax | 903-593-4689
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Provider Business Mailing Address
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Address Line | 1733 TROUP HWY
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City | TYLER
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State | TX
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Zip | 75701-5869
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Country | US
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Telephone | 903-593-1590
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Fax | 903-593-4689
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KIMBERLY KENNEDY
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Credential | CMF
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Telephone | 903-593-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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