MEDICARE: KATERRELL LEON 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235558628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERRELL LEON KENNEDY

Provider Business Mailing Address
First Line	:	402 DUNCAN ST
Second Line	:
City	:	FRANKLIN
State	:	KY
Zip	:	42134-1628
Country	:	US
Telephone Number	:	270-954-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 TENNESSEE WAY
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3160
Country	:	US
Telephone Number	:	629-255-0339
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	12/23/2024

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Directions to “ KATERRELL LEON KENNEDY ” Practice Location

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