MEDICARE: KENNEDY LAUREN BROWN

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	2255A2300X	Athletic Trainer		FL

General Provider Information

NPI Number	:	1932779873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY LAUREN BROWN

Provider Business Mailing Address
First Line	:	5529 LEXINGTON AVE
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-1834
Country	:	US
Telephone Number	:	501-563-9517
Fax Number	:

Provider Business Practice Location Address
First Line	:	5529 LEXINGTON AVE
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-1834
Country	:	US
Telephone Number	:	501-563-9517
Fax Number	:

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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Directions to “ KENNEDY LAUREN BROWN ” Practice Location

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