Individual
KENNEDY KRISTINE BASHIR IWAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2177 WENTWORTH DR, ROCHESTER HILLS, MI 48307-4283
(248) 979-1695
Mailing address
2177 WENTWORTH DR, ROCHESTER HILLS, MI 48307-4283
(248) 979-1695
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601013758
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MI
Other
Enumeration date
11/01/2023
Last updated
01/15/2026
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