MEDICARE: JESSICA ANN NICOLE KENNEDY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1912661216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN NICOLE KENNEDY PA-C

Provider Business Mailing Address
First Line	:	21200 BROOKPARK RD APT 317
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3113
Country	:	US
Telephone Number	:	216-440-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1928
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	08/28/2024

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