Healthcare Provider Details

I. General information

NPI: 1225090897
Provider Name (Legal Business Name): ANGELA S KENNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 N SCOTTSDALE RD STE. 150
SCOTTSDALE AZ
85253-2750
US

IV. Provider business mailing address

7085 W ANDREW LN
PEORIA AZ
85383-3039
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-7939
  • Fax: 480-946-5258
Mailing address:
  • Phone: 623-455-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3215
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: