| Doctor Name: | KEISHA KENNEDY |
| NPI Number: | 1033474101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PLMSW |
| License Number: | |
| Business Practice Address: | 602 N Walton Blvd Bentonville, AR - 727124576 |
| Business Phone Number: | 8703944643 |
| Business Fax Number: | 8703944646 |
| Mailing Address: | 602 N Walton Blvd, BENTONVILLE |
| State: | AR |
| Postal Code: | 727124576 |
| Phone Number: | 4794641060 |
| Fax Number: | 4792716307 |
| NPI Enumeration Date: | 07/05/2012 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |