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NPI Code Detail

MEDICARE: MELISSA R KENNEDY PA

MEDICARE: MELISSA R KENNEDY PA
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
1363A00000XPhysician Assistant9906MN

Other Identifiers

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

General Provider Information

NPI Number : 1487616959
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA R KENNEDY PA
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-9000
Fax Number :
Provider Business Practice Location Address
First Line : 755 CROSSROADS CAMPUS DR NE
Second Line :
City : BUFFALO
State : MN
Zip : 55313-5074
Country : US
Telephone Number : 763-684-6300
Fax Number : 763-684-6305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 05/23/2023

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Directions to “ MELISSA R KENNEDY PA” Practice Location

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