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NPI Code Detail

MEDICARE: HELEN B. KENNEDY NP

MEDICARE: HELEN B. KENNEDY NP
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
1363LF0000XFamily Nurse Practitioner209-000148IL

General Provider Information

NPI Number : 1538248786
Entity Type Code : Individual
Provider Name (Legal Business Name) : HELEN B. KENNEDY NP
Provider Business Mailing Address
First Line : 4965 E LOST BRIDGE RD
Second Line :
City : DECATUR
State : IL
Zip : 62521-5139
Country : US
Telephone Number : 217-864-5531
Fax Number :
Provider Business Practice Location Address
First Line : 4965 E LOST BRIDGE RD
Second Line :
City : DECATUR
State : IL
Zip : 62521-5139
Country : US
Telephone Number : 217-864-5531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 12/30/2021

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Directions to “ HELEN B. KENNEDY NP” Practice Location

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