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General NPI Number Information
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NPI Number | 1780078576
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Entity Type | Individual
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Provider Name | RACHEL GALE KENNEDY NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | G3494 BEECHER RD
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City | FLINT
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State | MI
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Zip | 48532-2735
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Country | US
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Telephone | 810-309-9734
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Fax | 810-768-1171
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Provider Business Mailing Address
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Address Line | G3494 BEECHER RD
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City | FLINT
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State | MI
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Zip | 48532-2735
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Country | US
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Telephone | 810-309-9734
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Fax | 810-768-1171
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4704285802
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License Number State | MI
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