Provider Demographics
NPI:1730993908
Name:KENNEDY, SUMMER JOY
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:JOY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUMMER
Other - Middle Name:JOY
Other - Last Name:HUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 WILLOW OAK CIR APT 306
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6823
Mailing Address - Country:US
Mailing Address - Phone:813-344-6391
Mailing Address - Fax:
Practice Address - Street 1:306 LIBERTY VIEW LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2291
Practice Address - Country:US
Practice Address - Phone:434-592-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program