Provider Demographics
NPI:1316487044
Name:KENNEDY, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NORTHCREEK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2096
Mailing Address - Country:US
Mailing Address - Phone:615-859-9902
Mailing Address - Fax:615-859-9906
Practice Address - Street 1:304 NORTHCREEK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2096
Practice Address - Country:US
Practice Address - Phone:615-859-9902
Practice Address - Fax:615-859-9906
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health