Provider Demographics
NPI:1477287241
Name:KENNEDY, CASSANDRA LATISHA (RN REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:LATISHA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALC
Mailing Address - Street 1:3701 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5015
Mailing Address - Country:US
Mailing Address - Phone:205-554-2000
Mailing Address - Fax:
Practice Address - Street 1:3802 OFFICER TREVOR S PHILLIPS AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7051
Practice Address - Country:US
Practice Address - Phone:205-722-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-091260163W00000X
ALALC05699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1801846126OtherGOVERNMENT