Provider Demographics
NPI:1386767978
Name:KENNEDY, SHANNON K (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:K
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:SMOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15480-0009
Mailing Address - Country:US
Mailing Address - Phone:724-677-0177
Mailing Address - Fax:
Practice Address - Street 1:119 N BEESON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2975
Practice Address - Country:US
Practice Address - Phone:724-437-6050
Practice Address - Fax:724-437-4418
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN512268L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse