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Individual
KATHERINE A. KENNON
Active
Individual
KATHERINE A. KENNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03288
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180742201
—
TX
01
—
88N997
BCBS
TX
01
—
970024986
RR MEDICARE
TX
Enumeration date
01/23/2007
Last updated
09/15/2011
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