Provider Demographics
NPI:1619838893
Name:KENNEDY, SEPTEMBER MARIE LYNN (RN, CLC)
Entity type:Individual
Prefix:MRS
First Name:SEPTEMBER
Middle Name:MARIE LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CRAMER PL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1328
Mailing Address - Country:US
Mailing Address - Phone:765-318-5040
Mailing Address - Fax:
Practice Address - Street 1:95 CRAMER PL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1328
Practice Address - Country:US
Practice Address - Phone:765-318-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28245991A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant