Individual
KENNERLY CLINTON PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 EAST MARSHALL ST, RICHMOND, VA 23298
(804) 828-9682
(804) 828-7567
Mailing address
1101 EAST MARSHALL ST. PO BOX 980160, RICHMOND, VA 23298
(804) 828-9682
(804) 828-7567
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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