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General NPI Number Information
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NPI Number | 1518462290
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Entity Type | Individual
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Provider Name | KENAN STEWART PRENTICE PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 125 BAPTIST WAY STE 4C
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City | PENSACOLA
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State | FL
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Zip | 32503-2274
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Country | US
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Telephone | 448-227-6330
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Fax | 850-626-9606
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Provider Business Mailing Address
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Address Line | PO BOX 95590
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0590
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-7976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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