Basic Information
Provider Information | |||||||||
NPI: | 1467992792 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KENNEDY | ||||||||
FirstName: | ANNA | ||||||||
MiddleName: | CATHEY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DNP, CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CATHEY | ||||||||
OtherFirstName: | ANNA | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DNP, CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 601 W MAPLE AVE STE 503 | ||||||||
Address2: |   | ||||||||
City: | SPRINGDALE | ||||||||
State: | AR | ||||||||
PostalCode: | 727645376 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4797513722 | ||||||||
FaxNumber: | 4797511099 | ||||||||
Practice Location | |||||||||
Address1: | 601 W MAPLE AVE STE 503 | ||||||||
Address2: |   | ||||||||
City: | SPRINGDALE | ||||||||
State: | AR | ||||||||
PostalCode: | 727645376 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4797513722 | ||||||||
FaxNumber: | 4797511099 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2017 | ||||||||
LastUpdateDate: | 04/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C003177 | AR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.