Doctor Name: | MS. PATRICE L KENNEDY |
NPI Number: | 1164450789 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 263948-4405 |
Business Practice Address: | 500 Foothill Drive Slc, TN - 84148 |
Business Phone Number: | 8015821565 |
Business Fax Number: | |
Mailing Address: | 7898 Showcase Ln, SANDY |
State: | UT |
Postal Code: | 840947252 |
Phone Number: | 8015650136 |
Fax Number: | |
NPI Enumeration Date: | 06/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 263948-4405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |