Most Relevant Information
Provider Data
| NPI Number: | 1003299074 |
| Provider Name: | MAMIE KENNEDY CRNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 1-116711 |
Most Important Dates
| Enumeration Date: | 07/08/2015 |
| Last Updated: | 07/08/2015 |
Provider Practice Location
1121 BELLEVILLE AVE
BREWTON
AL
364261500
Practice Location Phone/Fax
| Phone: | 2518093208 |
| Fax: | 2518675999 |
Provider Mailing Location
1121 BELLEVILLE AVE
BREWTON
AL
364261500
Provider Mailing Phone/Fax
| Phone: | 2518093208 |
| Fax: | 2518675999 |