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NPI Code Detail

MEDICARE: KALEE KENNEDY

MEDICARE: KALEE KENNEDY
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1750914339
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALEE KENNEDY
Provider Business Mailing Address
First Line : WASHINGTON STATE UNIVERSITY
Second Line : 160 CLEVELAND HALL PO BOX 642114 1155 COLLEGE AVE
City : PULLMAN
State : WA
Zip : 99164
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : WASHINGTON STATE UNIVERSITY
Second Line : 160 CLEVELAND HALL 1155 COLLEGE AVE
City : PULLMAN
State : WA
Zip : 99164
Country : US
Telephone Number : 509-335-3564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2020
Last Update Date : 02/21/2020

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