| Doctor Name: | DANA KENNEDY |
| NPI Number: | 1578921110 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-PC |
| License Number: | AP130127 |
| Business Practice Address: | 227 S Gun Barrel Ln Gun Barrel City, TX - 751563851 |
| Business Phone Number: | 9038878884 |
| Business Fax Number: | |
| Mailing Address: | 112 Forest Ridge Rd, TRINIDAD |
| State: | TX |
| Postal Code: | 751632215 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2016 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | AP130127 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |