Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD456475 | PA |
Y | 2080P0201X | Pediatric Allergist | MD456475 | PA |
NPI | 1588008171 |
---|---|
Provider Name | Katie Kennedy |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 26/06/2019 |