Basic Information
| Provider Information | |||||||||
| NPI: | 1063540219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEY | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 GLENDALE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471111708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023869144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2944 BRECKENRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402201409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028930159 | ||||||||
| FaxNumber: | 5022133853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 17001508A | IN | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 101271 | KY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.