Provider Demographics
NPI:1871057349
Name:KENNARD, MICHELLE LEE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:KENNARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9609
Mailing Address - Country:US
Mailing Address - Phone:740-616-1233
Mailing Address - Fax:
Practice Address - Street 1:299 KINGS DAUGHTERS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4186
Practice Address - Country:US
Practice Address - Phone:524-050-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018247363LF0000X
OHAPRN.CNP.024112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily