Provider Demographics
NPI:1336965821
Name:KENNEDY, ALEXIS (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 GEORGE ZEIGER DR APT 411
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7612
Mailing Address - Country:US
Mailing Address - Phone:216-776-8850
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2333 HARVARD ROAD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4412
Practice Address - Country:US
Practice Address - Phone:216-593-2200
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH527674163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine