| Doctor Name: | MARY KATHERINE KENNEY |
| NPI Number: | 1003299082 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 085005526 |
| Business Practice Address: | 3131 N Water St Decatur, IL - 625262472 |
| Business Phone Number: | 2178765320 |
| Business Fax Number: | |
| Mailing Address: | 2844 S Forrest Ln, DECATUR |
| State: | IL |
| Postal Code: | 625215415 |
| Phone Number: | 2172019314 |
| Fax Number: | |
| NPI Enumeration Date: | 07/08/2015 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085005526 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |