| Doctor Name: | MS. COLLEEN MARIE KENNEDY |
| NPI Number: | 1154302388 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA9101536 |
| Business Practice Address: | 425 Centre View Blvd Crestview Hills, KY - 410173409 |
| Business Phone Number: | 8593413575 |
| Business Fax Number: | 8593415702 |
| Mailing Address: | 425 Centre View Blvd, CRESTVIEW HILLS |
| State: | KY |
| Postal Code: | 410173409 |
| Phone Number: | 8593413575 |
| Fax Number: | 8593415702 |
| NPI Enumeration Date: | 11/05/2005 |
| NPI Last Update Date: | 02/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9101536 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |