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NPI Code Detail

MEDICARE: JOHNITA KENNEDY-KEYES NORMAN M.D.

MEDICARE: JOHNITA KENNEDY-KEYES NORMAN M.D.
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
1208000000XPediatrics PhysicianMD0000024994TN

General Provider Information

NPI Number : 1548360753
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNITA KENNEDY-KEYES NORMAN M.D.
Provider Business Mailing Address
First Line : 3876 NEW COVINGTON PIKE
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2512
Country : US
Telephone Number : 901-377-2711
Fax Number : 901-387-2036
Provider Business Practice Location Address
First Line : 3876 NEW COVINGTON PIKE
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2512
Country : US
Telephone Number : 901-377-2711
Fax Number : 901-387-2036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/08/2007

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