Individual
KENNEDY BEAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4199 GATEWAY BLVD, NEWBURGH, IN 47630-8940
(812) 842-4200
Mailing address
PO BOX 637273, CINCINNATI, OH 45263-7273
(812) 842-4260
(812) 602-3174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003619A
IN
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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