MEDICARE: KENNEDY EMMA ISABELLE PLEETS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1679404750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY EMMA ISABELLE PLEETS

Provider Business Mailing Address
First Line	:	8850 LOANS HIM ARROW LOOP
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-2202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8850 LOANS HIM ARROW LOOP
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-2202
Country	:	US
Telephone Number	:	701-301-4323
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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