Provider Demographics
NPI:1417271677
Name:KENNEDY, LESLIE HAMMETT (NP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:HAMMETT
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 EAST STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6654
Practice Address - Fax:864-560-6017
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC77079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA54586067OtherMEDICARE PIN
SCNP1936Medicaid
SCAA54585019OtherMEDICARE PIN
SCAA54589225OtherMEDICARE PIN
SCAA54589068OtherMEDICARE PIN
NC7004720Medicaid
SCAA54583365OtherMEDICARE PIN