Healthcare Provider Details

I. General information

NPI: 1851947857
Provider Name (Legal Business Name): BRANDI ELIZABETH KENNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

1800 MULBERRY ST
SCRANTON PA
18510
US

V. Phone/Fax

Practice location:
  • Phone: 570-687-1594
  • Fax:
Mailing address:
  • Phone: 570-703-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060754
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA060754
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMA060754
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: