Doctor Name: | MICHELLE M KENNEDY |
NPI Number: | 1104094424 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RNC WHNP |
License Number: | 946 |
Business Practice Address: | 222 Tongass Dr 514 Lake Street Suite B Sitka, AK - 998359416 |
Business Phone Number: | 9079668772 |
Business Fax Number: | 9079668708 |
Mailing Address: | 109 Bahrt Cir, SITKA |
State: | AK |
Postal Code: | 998357237 |
Phone Number: | 9079668772 |
Fax Number: | |
NPI Enumeration Date: | 02/20/2008 |
NPI Last Update Date: | 06/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 946 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |