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General NPI Number Information
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NPI Number | 1588583710
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Entity Type | Individual
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Provider Name | MICHAEL SHAWN KENNEDY
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Gender | Male
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 113262 S 4620 RD
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City | SALLISAW
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State | OK
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Zip | 74955-7991
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Country | US
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Telephone | 918-315-0315
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Fax |
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Provider Business Mailing Address
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Address Line | 113262 S 4620 RD
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City | SALLISAW
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State | OK
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Zip | 74955-7991
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Country | US
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Telephone | 918-315-0315
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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