Healthcare Provider Details

I. General information

NPI: 1265057038
Provider Name (Legal Business Name): MATTHEW LAWRENCE KENNEDY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

IV. Provider business mailing address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

V. Phone/Fax

Practice location:
  • Phone: 509-603-5177
  • Fax:
Mailing address:
  • Phone: 509-603-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61451512
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: