MEDICARE: KENNEDY DOYLE PMHNP-BC

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	363L00000X	Nurse Practitioner	71016339A	IN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71016339A	IN

General Provider Information

NPI Number	:	1679370092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY DOYLE PMHNP-BC

Provider Business Mailing Address
First Line	:	530 BENTEE WES CT
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4037
Country	:	US
Telephone Number	:	812-401-1836
Fax Number	:	812-401-8013

Provider Business Practice Location Address
First Line	:	530 BENTEE WES CT
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4037
Country	:	US
Telephone Number	:	812-401-1836
Fax Number	:	812-401-8013

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	05/14/2026

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