Provider Demographics
NPI:1972074060
Name:KENNEDY, KATHERINE ANNE (RN)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 BRANDON OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5816
Mailing Address - Country:US
Mailing Address - Phone:210-812-0079
Mailing Address - Fax:
Practice Address - Street 1:11830 BRANDON OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5816
Practice Address - Country:US
Practice Address - Phone:210-812-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX906920163W00000X, 163WP0200X, 163WC0400X, 163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice