MEDICARE: KENNEDY WASHINGTON

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		AR

General Provider Information

NPI Number	:	1477407807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY WASHINGTON

Provider Business Mailing Address
First Line	:	9409 JOHNSON RD
Second Line	:
City	:	MABELVALE
State	:	AR
Zip	:	72103-2951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10801 PAUL EELLS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-7608
Country	:	US
Telephone Number	:	501-234-0950
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ KENNEDY WASHINGTON ” Practice Location

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