Provider Demographics
NPI:1487526554
Name:KENNEDY, KIMBERLY ELAINE (BSN, RN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 W METALINE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2343
Mailing Address - Country:US
Mailing Address - Phone:509-544-3516
Mailing Address - Fax:
Practice Address - Street 1:1300 W EPHRATA
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326
Practice Address - Country:US
Practice Address - Phone:509-544-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00145824261QP2400X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health