Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35-086281 | OH |
Y | 111NI0900X | Internist | 35-086281 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35.086281 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 43946 | KY |
NPI | 1881650885 |
---|---|
Provider Name | Laura Cancilla Kenny |
First Address | Florence, KY 41042 |
Second Address | Florence, KY 41042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200523050 | (05) | IN |
2594581 | (05) | OH |
6410106600 | (05) | KY |
I11839 | (02) | |
P00224928 | RAIL ROAD MEDICARE (01) | OH |