MEDICARE: KENNEDY NICOLE BAY I

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	9370-83-3209	IN

General Provider Information

NPI Number	:	1588514525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY NICOLE BAY I

Provider Business Mailing Address
First Line	:	5196 E GREENSBURG RD
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-8201
Country	:	US
Telephone Number	:	317-560-9952
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 W STONES CROSSING RD STE 120
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7899
Country	:	US
Telephone Number	:	317-960-4047
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ KENNEDY NICOLE BAY I ” Practice Location

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