Provider Demographics
NPI:1225853823
Name:KENNEDY, BRANDY JANE (RN, CCM)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JANE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:JANE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 LCR 781
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2211
Mailing Address - Country:US
Mailing Address - Phone:903-388-0871
Mailing Address - Fax:
Practice Address - Street 1:701 MCCLINTIC DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2128
Practice Address - Country:US
Practice Address - Phone:254-729-3281
Practice Address - Fax:254-729-4306
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770512163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management