Kennedy, Craig Allen

Kennedy, Craig Allen is an sole proprietor health care provider with primary practice located at 1530 Bixby Rd , Mounds OK 74047-5335. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kennedy, Craig Allen can be contacted via phone (918) 366-9152.

Contact Information

Primary practice address
1530 Bixby Rd Mounds OK 74047-5335
Phone: (918) 366-9152
Fax: (918) 366-1170
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 14981 Oklahoma

Profile Details

NPI number 1356332555
LBN Legal business name Kennedy, Craig Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 4th, 2005
Last updated Mar 23rd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356332555 NPPES
Oklahoma Other 930085465 RAILROAD MEDICARE
Oklahoma MEDICAID 100790580D RAILROAD MEDICARE

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