MEDICARE: SARAH ANNE KENNEDY DO

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	207V00000X	Obstetrics & Gynecology Physician	U4238	TX

General Provider Information

NPI Number	:	1275198988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANNE KENNEDY DO

Provider Business Mailing Address
First Line	:	12201 MERIT DR STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3117
Country	:	US
Telephone Number	:	469-840-4888
Fax Number	:	469-840-4886

Provider Business Practice Location Address
First Line	:	12201 MERIT DR STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3117
Country	:	US
Telephone Number	:	469-840-4888
Fax Number	:	469-840-4886

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

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	08/01/2023

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