MEDICARE: MR. KENNETH WILLOUGHBY JR. 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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	4370	SC

General Provider Information

NPI Number	:	1427240019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH WILLOUGHBY JR. PA-C

Provider Business Mailing Address
First Line	:	32051 GROVE ST
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-1906
Country	:	US
Telephone Number	:	440-930-2802
Fax Number	:

Provider Business Practice Location Address
First Line	:	32051 GROVE ST
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-1906
Country	:	US
Telephone Number	:	440-930-2802
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	05/06/2025

Similar Medicare Providers

1316492127 — LAUREN ANN HUGHES
Practice Location Address:

72 FREYMUTH RD
LAKE ST LOUIS, MO
63367-1906

Practice Phone: 678-909-9253
Practice Fax:

1861613242 — MRS. AMANDA SUE AL-KHUDAIRI MSN, RNC, APRN
Practice Location Address:

1906 W 3600 S
SALT LAKE CITY, UT
84119-4715

Practice Phone: 801-973-9675
Practice Fax:

1992919385 — TANIA LOPEZ
Practice Location Address:

1906 N A ST
LAKE WORTH, FL
33460-6002

Practice Phone: 561-541-1387
Practice Fax: 561-540-5491

1003007691 — JENNIFER DEBORA HUDSON MA, LMHC, CMHS
Practice Location Address:

1906 82ND AVE NE
LAKE STEVENS, WA
98258

Practice Phone: 425-397-6284
Practice Fax:

1659609014 — NUESTRA CASA
Practice Location Address:

1906 N A ST
LAKE WORTH, FL
33460-6002

Practice Phone: 561-493-1785
Practice Fax:

1457601601 — INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Practice Location Address:

130 LAKE CONCORD RD NE STE B
CONCORD, NC
28025-1906

Practice Phone: 704-786-4482
Practice Fax:

Directions to “ MR. KENNETH WILLOUGHBY JR. PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.