Healthcare Provider Details

I. General information

NPI: 1467949495
Provider Name (Legal Business Name): CLAIRE KENNEDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10452 SILVERDALE WAY NW
SILVERDALE WA
98383-9411
US

IV. Provider business mailing address

10452 SILVERDALE WAY NW
SILVERDALE WA
98383-9411
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-7300
  • Fax: 360-307-7304
Mailing address:
  • Phone: 360-307-7300
  • Fax: 360-307-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60939801
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: