MEDICARE: PRECIOUS MYESHA 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
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1891453775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRECIOUS MYESHA KENNEDY

Provider Business Mailing Address
First Line	:	9129 N SWAN RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-1703
Country	:	US
Telephone Number	:	414-213-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	9129 N SWAN RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-1703
Country	:	US
Telephone Number	:	414-213-7758
Fax Number	:

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

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	12/07/2021

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Directions to “ PRECIOUS MYESHA KENNEDY ” Practice Location

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