Provider Demographics
NPI:1063892107
Name:KENNEDY, SHERILL D (MSN, APRN, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHERILL
Middle Name:D
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSN, APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 MCFARLAND DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4078
Mailing Address - Country:US
Mailing Address - Phone:330-881-7812
Mailing Address - Fax:
Practice Address - Street 1:2617 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1757
Practice Address - Country:US
Practice Address - Phone:281-651-4660
Practice Address - Fax:281-651-4806
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126787363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health