Provider Demographics
NPI:1568285666
Name:KENNEDY, ASHLEY J
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 SANDY AVE SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1812
Mailing Address - Country:US
Mailing Address - Phone:330-495-6847
Mailing Address - Fax:
Practice Address - Street 1:6505 VALLEY DR SE
Practice Address - Street 2:
Practice Address - City:EAST SPARTA
Practice Address - State:OH
Practice Address - Zip Code:44626-9519
Practice Address - Country:US
Practice Address - Phone:304-841-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide