Provider Demographics
NPI:1053094649
Name:KENNEY, ROBERTA Y
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:Y
Last Name:KENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 CYNTHIA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1113
Mailing Address - Country:US
Mailing Address - Phone:502-608-2858
Mailing Address - Fax:
Practice Address - Street 1:5604 CYNTHIA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1113
Practice Address - Country:US
Practice Address - Phone:502-608-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health