Healthcare Provider Details

I. General information

NPI: 1992472021
Provider Name (Legal Business Name): CHLOE KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13033 NE BEL RED RD STE 120
BELLEVUE WA
98005-2633
US

IV. Provider business mailing address

13033 NE BEL RED RD STE 120
BELLEVUE WA
98005-2633
US

V. Phone/Fax

Practice location:
  • Phone: 425-440-3351
  • Fax:
Mailing address:
  • Phone: 425-440-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61507836
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: