Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | N6416 | TX |
NPI | 1326186131 |
---|---|
Provider Name | Sarah Lynn Kennedy |
First Address | Arlington, TX 76017-1517 |
Second Address | Arlington, TX 76017-1517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 21/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339171601 | (05) | TX |
8EQ081 | BCBS (01) | TX |
P01447522 | RAILROAD MEDICARE (01) | TX |