MEDICARE: BRENDA SUE KENNEDY LPN

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	164W00000X	Licensed Practical Nurse	164W00000X	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2309657	OTHER	OH	PROVIDER

General Provider Information

NPI Number	:	1841265030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA SUE KENNEDY LPN

Provider Business Mailing Address
First Line	:	7677 COLUMBUS RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9325
Country	:	US
Telephone Number	:	740-397-2406
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 COUNTY ROAD 201
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9646
Country	:	US
Telephone Number	:	740-625-6825
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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