Provider Demographics
NPI:1538248786
Name:KENNEDY, HELEN B (NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:B
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4965 E LOST BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5139
Mailing Address - Country:US
Mailing Address - Phone:217-864-5531
Mailing Address - Fax:
Practice Address - Street 1:4965 E LOST BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5139
Practice Address - Country:US
Practice Address - Phone:217-864-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S13196Medicare UPIN