Basic Information
| Provider Information | |||||||||
| NPI: | 1912352501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KENNY | ||||||||
| FirstName: | CAITLYN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT RD # CBO 2/3 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133519900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3955 ALEXANDRIA PIKE | ||||||||
| Address2: | |||||||||
| City: | COLD SPRING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410762027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594428700 | ||||||||
| FaxNumber: | 8594428718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2016 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 54033 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 54033 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.