Individual
DR. LISA SHEA KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
403 E MEEKER ST STE 200, KENT, WA 98030-5904
(253) 852-2866
(253) 852-3102
Mailing address
955 POWELL AVE SW, RENTON, WA 98057-2908
(425) 277-1311
(425) 277-1566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101039112
VA
207Q00000X
Family Medicine Physician
Primary
MD60952683
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320601
ANTHEM PROVIDER #
VA
01
—
320602
ANTHEM HEALTHKEEPERS #
VA
01
—
4107755
AETNA PROVIDER #
VA
05
—
5624959
—
VA
Enumeration date
08/01/2006
Last updated
03/06/2025
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