Healthcare Provider Details

I. General information

NPI: 1386519320
Provider Name (Legal Business Name): MAJENNEH KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNAH KENNEDY

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7300
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8000
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA067257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: