Healthcare Provider Details

I. General information

NPI: 1114708112
Provider Name (Legal Business Name): BRIGID ELIZABETH KENNEDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY STE 4
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

5 MORGAN HWY STE 4
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMA064830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: