Organization
THE KENNEDY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD MICHAEL KENNEDY PA-C (MANAGING MEMBER)
(423) 432-3130
Entity
Organization
Contact information
Practice address
4957 SWINYAR DR STE 109, OOLTEWAH, TN 37363-2205
(423) 396-9893
(423) 396-9508
Mailing address
4957 SWINYAR DR, SUITE 109, OOLTEWAH, TN 37363
(423) 432-3130
(423) 396-9508
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942280052
KENNEDY NPI#
TN
01
—
413276426
KENNEDY SS#
TN
01
—
4136940
KENNEDY BCBS
TN
Enumeration date
05/04/2007
Last updated
09/12/2024
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