Provider Demographics
NPI:1083434997
Name:KENNEDY, TIARRA (MD)
Entity type:Individual
Prefix:
First Name:TIARRA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIARRA
Other - Middle Name:
Other - Last Name:RANSOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 67656
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-0017
Mailing Address - Country:US
Mailing Address - Phone:443-704-6777
Mailing Address - Fax:
Practice Address - Street 1:1829 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6320
Practice Address - Country:US
Practice Address - Phone:443-704-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TC1900X, 1041C0700X, 106H00000X, 171000000X, 171M00000X, 173000000X, 176B00000X
MD374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171000000XOther Service ProvidersMilitary Health Care Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No173000000XOther Service ProvidersLegal Medicine
No374J00000XNursing Service Related ProvidersDoula