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General NPI Number Information
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NPI Number | 1093098097
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Entity Type | Organization
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Legal Business Name | PAMELA S. KENNEDY, MD, P.A.
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 1355 THOMASWOOD DRIVE
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-656-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 THOMASWOOD DRIVE
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-656-4555
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | PAMELA KENNEDY
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Credential | M.D.
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Telephone | 850-656-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME 84319
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License Number State | FL
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