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KENNEDY FAYRENE WALLACE
NPI 1386539120
Student in an Organized Health Care Education/Training Program in Atlanta, GA

Active since June 11, 2025
720 WESTVIEW DR SW, ATLANTA, GA 30310(404) 756-1959 Get Directions Write a Review

NPPES record last updated: June 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kennedy Fayrene Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNEDY FAYRENE WALLACE (NPI 1386539120) is an individual student in an organized health care education/training program in Atlanta, Georgia and active in the NPI registry since June 2025.

NPPES Registry Identity

NPI1386539120
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKENNEDY FAYRENE WALLACE
Location Address720 WESTVIEW DR SWAtlanta, GA 30310-1458
Mailing Address17703 Laguna Trail DrHouston, TX 77095-7163 · (281) 978-1429
Phone(404) 756-1959
Sole ProprietorYes
Enumeration DateJune 11, 2025
NPPES CertifiedJune 7, 2025
✔ NPI 1386539120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
720 WESTVIEW DR SW, Atlanta, GA 30310
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRYAN OSAYAMHEN OKOSUN
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1500
UGOCHI GLADYS ANANABA
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1500
DR. THEODORA CHIDERA ABAH MD
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1400
DR. ALEX WALEED MOHAMMAD ALQUDAH MD
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 756-1341
YOG VAGHANI
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1500
BRADFORD ZACHARY GRANT
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1500
NIRVANA ALLISON DURBAL
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 752-1500
IVANNA ALEXIS WARD DO
Student in an Organized Health Care Education/Training Program
720 WESTVIEW DR SW
ATLANTA, GA 30310
Fulton County (404) 756-1383

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kennedy Wallace's NPI number?

The NPI number for Kennedy Wallace is 1386539120. It was assigned to this individual provider in the NPPES registry on June 11, 2025.

Where is Kennedy Wallace located?

Kennedy Wallace practices at 720 Westview Dr SW, Atlanta, GA 30310. The listed phone number is (404) 756-1959.

What is Kennedy Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Kennedy Wallace was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.