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Individual
KENNERLY CLINTON PATRICK
Active
Individual
KENNERLY CLINTON PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0102207203
VA
207RN0300X
Nephrology Physician
Primary
0102207203
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2017
Last updated
08/17/2022
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