MEDICARE: KATHY KENNEDY

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1174681381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY KENNEDY

Provider Business Mailing Address
First Line	:	3345 MILITARY ST APT 111
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 KEEWAHDIN RD LOT 78
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3490
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/20/2024

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Directions to “ KATHY KENNEDY ” Practice Location

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