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General NPI Number Information
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NPI Number | 1841492568
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Entity Type | Individual
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Provider Name | KEVIN D KENNEDY PT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 1200 N STATE ST SUITE 500
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City | JACKSON
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State | MS
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Zip | 39202-2000
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Country | US
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Telephone | 601-352-2273
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Fax | 601-714-3415
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Provider Business Mailing Address
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Address Line | 1600 N STATE ST SUITE 400
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City | JACKSON
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State | MS
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Zip | 39202-1689
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Country | US
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Telephone | 601-944-1717
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Fax | 601-944-9780
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3757
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License Number State | MS
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