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NPI Code Detail

MEDICARE: COURTNEY KENNEDY RBT

MEDICARE: COURTNEY KENNEDY RBT
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
1247200000XOther TechnicianRBT-18-60710TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RBT-18-60710OTHERTXBACB

General Provider Information

NPI Number : 1871077313
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY KENNEDY RBT
Provider Business Mailing Address
First Line : 3100 PREMIER DR STE 234
Second Line :
City : IRVING
State : TX
Zip : 75063-2693
Country : US
Telephone Number : 972-756-1222
Fax Number : 469-374-0800
Provider Business Practice Location Address
First Line : 3100 PREMIER DR STE 234
Second Line :
City : IRVING
State : TX
Zip : 75063-2693
Country : US
Telephone Number : 972-756-1222
Fax Number : 469-374-0800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2018
Last Update Date : 09/20/2018

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Directions to “ COURTNEY KENNEDY RBT” Practice Location

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