Individual
MS. COLLEEN MARIE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
425 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3409
(859) 341-3575
(859) 341-5702
Mailing address
425 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3409
(859) 341-3575
(859) 341-5702
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1114
KY
363AM0700X
Medical Physician Assistant
PA1114
KY
363AM0700X
Medical Physician Assistant
PA9101536
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291895100
—
FL
05
—
7100320670
—
KY
Enumeration date
11/05/2005
Last updated
02/16/2015
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