Kennedy, Katherine Edithe

Kennedy, Katherine Edithe is an sole proprietor health care provider with primary practice located at 1728 W Glendale Ave Ste 100 , Phoenix AZ 85021-8862. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Kennedy, Katherine Edithe can be contacted via phone (480) 812-3668.

Contact Information

Primary practice address
1728 W Glendale Ave Ste 100 Phoenix AZ 85021-8862
Phone: (480) 812-3668
Fax: (480) 782-1290
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 135.000790 Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 0818 Arizona

Profile Details

NPI number 1316290893
LBN Legal business name Kennedy, Katherine Edithe
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 20th, 2012
Last updated Sep 12th, 2019 - about 7 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 1316290893 NPPES
Arizona MEDICAID Z179475

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