MEDICARE: MR. HOWARD MICHAEL KENNEDY 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	408	TN
2	363A00000X	Physician Assistant	408	TN

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	:	1942280052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HOWARD MICHAEL KENNEDY JR. PA-C

Provider Business Mailing Address
First Line	:	4957 SWINYAR DR STE 109
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2205
Country	:	US
Telephone Number	:	423-432-3130
Fax Number	:	423-396-9508

Provider Business Practice Location Address
First Line	:	4957 SWINYAR DR STE 109
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2205
Country	:	US
Telephone Number	:	423-432-3130
Fax Number	:	423-396-9508

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	01/26/2024

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