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Individual
ANDRE JOHNATHAN KENNEDY
Active
Individual
ANDRE JOHNATHAN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2832
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2832
SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION
SC
Enumeration date
01/31/2018
Last updated
05/26/2021
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