MEDICARE: DAWN KENNEDY MA, LPA, HSP-PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6242	NC

General Provider Information

NPI Number	:	1013628460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN KENNEDY MA, LPA, HSP-PA

Provider Business Mailing Address
First Line	:	4705 UNIVERSITY DR BLDG 700
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3489
Country	:	US
Telephone Number	:	919-237-1337
Fax Number	:	866-538-4716

Provider Business Practice Location Address
First Line	:	1004 WERRINGTON DR STE 200
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6018
Country	:	US
Telephone Number	:	919-552-9952
Fax Number	:	919-552-3062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	10/02/2025

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