Provider Demographics
NPI:1528080967
Name:KENNEDY, KATHLEEN APRIL (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:APRIL
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 1:1325 E CHURCH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5915
Mailing Address - Country:US
Mailing Address - Phone:805-349-9393
Mailing Address - Fax:805-614-7929
Practice Address - Street 1:1325 E CHURCH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5915
Practice Address - Country:US
Practice Address - Phone:805-349-9393
Practice Address - Fax:805-614-7929
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24114207RH0003X
CAA82547207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK32703OtherOBNDD
A82547OtherCALIFORNIA
OKBK8273613OtherDEA
OKBK8273613OtherDEA