Healthcare Provider Details

I. General information

NPI: 1114508777
Provider Name (Legal Business Name): PABLO ANDRES KENNEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SAINT MARYS RD
JUNCTION CITY KS
66441-4139
US

IV. Provider business mailing address

4717 SW WANAMAKER RD
TOPEKA KS
66610-1333
US

V. Phone/Fax

Practice location:
  • Phone: 785-238-0325
  • Fax: 785-576-1113
Mailing address:
  • Phone: 785-438-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-50055
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: