Provider Demographics
NPI:1386807469
Name:KENNEDY, KARA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KARA
Other - Middle Name:ANN KENNEDY
Other - Last Name:FISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:J 401
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5661
Mailing Address - Fax:859-257-4999
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:J 401
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5661
Practice Address - Fax:859-257-4999
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY034232084N0400X
MO20100149232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100174920Medicaid