Provider Demographics
NPI:1194876920
Name:KENNEDY, SHARLENE K (N P)
Entity type:Individual
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First Name:SHARLENE
Middle Name:K
Last Name:KENNEDY
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Gender:F
Credentials:N P
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Mailing Address - Street 1:1085 S LINDEN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3421
Mailing Address - Country:US
Mailing Address - Phone:810-732-3240
Mailing Address - Fax:810-230-0280
Practice Address - Street 1:ONE HURLEY PLAZA
Practice Address - Street 2:NURSING ADMINISTRATION
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-257-9526
Practice Address - Fax:810-257-9471
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MI4704088180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4291971Medicaid
P 36157Medicare UPIN