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General NPI Number Information
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NPI Number | 1518684414
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Entity Type | Individual
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Provider Name | ERYN RENAE KENNERLY
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Gender | Female
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 154 CORNERSTONE LN
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6560
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Country | US
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Telephone | 501-520-0660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20681
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City | HOT SPRINGS
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State | AR
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Zip | 71903-0681
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Country | US
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Telephone | 501-802-2236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 202035
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License Number State | AR
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