Provider Demographics
NPI:1609687490
Name:HENKE, KENNEDI LYNN
Entity type:Individual
Prefix:
First Name:KENNEDI
Middle Name:LYNN
Last Name:HENKE
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 1:1703 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7471
Mailing Address - Country:US
Mailing Address - Phone:308-218-8509
Mailing Address - Fax:
Practice Address - Street 1:1703 COLUMBIA CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7471
Practice Address - Country:US
Practice Address - Phone:308-218-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant