Healthcare Provider Details

I. General information

NPI: 1174509491
Provider Name (Legal Business Name): PATRICK R KENNY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

121 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1862
  • Fax: 434-384-7704
Mailing address:
  • Phone: 434-384-1862
  • Fax: 434-384-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDOS-1001
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102204930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: