| Doctor Name: | MRS. FELICIA D KENNICOTT |
| NPI Number: | 1376710541 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 5317 |
| Business Practice Address: | 100 Goshen Rd Rincon, GA - 313265545 |
| Business Phone Number: | 9128266000 |
| Business Fax Number: | 9128266016 |
| Mailing Address: | Po Box 818, SPRINGFIELD |
| State: | GA |
| Postal Code: | 313290818 |
| Phone Number: | 9127546451 |
| Fax Number: | 9127549901 |
| NPI Enumeration Date: | 05/15/2008 |
| NPI Last Update Date: | 07/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |