Provider Demographics
NPI:1427088020
Name:KENNEDY, KATHRYN KAY (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KAY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 E BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5714
Mailing Address - Country:US
Mailing Address - Phone:318-212-3846
Mailing Address - Fax:318-212-3849
Practice Address - Street 1:1666 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE 220
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5714
Practice Address - Country:US
Practice Address - Phone:318-212-3846
Practice Address - Fax:318-212-3849
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0204842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339302Medicaid
LA4A831DB67Medicare PIN
G62115Medicare UPIN
LA4A831Medicare PIN