Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP126787 | TX |
NPI | 1063892107 |
---|---|
Provider Name | Ms. Sherill D. Kennedy |
First Address | College Station, TX 77845-4078 |
Second Address | Houston, TX 77025-1757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 03/06/2015 |