Provider Demographics
NPI:1992240840
Name:KENNEDY, KARA BREANNE I
Entity type:Individual
Prefix:MISS
First Name:KARA
Middle Name:BREANNE
Last Name:KENNEDY
Suffix:I
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 1:456 SAM THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9073
Mailing Address - Country:US
Mailing Address - Phone:256-665-5807
Mailing Address - Fax:
Practice Address - Street 1:456 SAM THOMAS RD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-9073
Practice Address - Country:US
Practice Address - Phone:256-665-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8709761106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician