Individual
MICHAEL STEVEN KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
145 HOSPITAL AVE, SUITE 211, DUBOIS, PA 15801-1464
(814) 375-3722
Mailing address
145 HOSPITAL AVE, SUITE 211, DUBOIS, PA 15801-1464
(814) 375-3722
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
SP026537
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP026537
PENNSYLVANIA STATE NURSE PRACTITIONER LICENSE
PA
Enumeration date
11/01/2022
Last updated
04/15/2026
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