MEDICARE: MR. CHRISTOPHER ANDREW KENNEDY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	01012	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255317640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER ANDREW KENNEDY PA-C

Provider Business Mailing Address
First Line	:	1249 15TH STREET
Second Line	:	SUITE 4093
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3662
Country	:	US
Telephone Number	:	304-691-6800
Fax Number	:	304-691-6751

Provider Business Practice Location Address
First Line	:	300 CORPORATE CENTER DRIVE
Second Line	:
City	:	SCOTT DEPOT
State	:	WV
Zip	:	25560
Country	:	US
Telephone Number	:	304-691-6800
Fax Number	:	304-691-6751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	12/20/2021

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Directions to “ MR. CHRISTOPHER ANDREW KENNEDY PA-C” Practice Location

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