| Doctor Name: | MS. PHILICIA KENNEDY |
| NPI Number: | 1003058249 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | RN164975 NP |
| Business Practice Address: | 3399 Ashford Pass Ellenwood, GA - 302943693 |
| Business Phone Number: | 6787057456 |
| Business Fax Number: | |
| Mailing Address: | 3399 Ashford Pass, ELLENWOOD |
| State: | GA |
| Postal Code: | 302943693 |
| Phone Number: | 6787057456 |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2009 |
| NPI Last Update Date: | 04/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | RN164975 NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |