| Doctor Name: | CRISWELL ALLEN KENNEDY |
| NPI Number: | 1912122847 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD00017804 |
| Business Practice Address: | 24128 E Alki Ln Liberty Lake, WA - 990199447 |
| Business Phone Number: | 5092555065 |
| Business Fax Number: | 5094776352 |
| Mailing Address: | 24128 E Alki Ln, LIBERTY LAKE |
| State: | WA |
| Postal Code: | 990199447 |
| Phone Number: | 5092555065 |
| Fax Number: | 5094776352 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD00017804 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |