MEDICARE: JANINE MARIE 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	5741	TN

General Provider Information

NPI Number	:	1780971945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE MARIE KENNEDY PA-C

Provider Business Mailing Address
First Line	:	9058 OLD LEE HWY
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5631
Country	:	US
Telephone Number	:	423-531-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	9058 OLD LEE HWY
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5631
Country	:	US
Telephone Number	:	423-531-9110
Fax Number	:	423-476-5887

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	04/02/2025

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