Provider Demographics
NPI:1043979495
Name:KENNEDY, ROSALITHA TENDEH
Entity type:Individual
Prefix:
First Name:ROSALITHA
Middle Name:TENDEH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 NADORFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47124-9303
Mailing Address - Country:US
Mailing Address - Phone:502-232-3405
Mailing Address - Fax:
Practice Address - Street 1:11860 NADORFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IN
Practice Address - Zip Code:47124-9303
Practice Address - Country:US
Practice Address - Phone:502-232-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily