Individual
TRACY KENNELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A-C
Contact information
Practice address
2200 NE NEFF RD STE 302, BEND, OR 97701-4279
(541) 706-6915
(541) 706-6733
Mailing address
PO BOX 6095, BEND, OR 97708-6095
(541) 706-5922
(541) 706-6869
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
51221
CA
363A00000X
Physician Assistant
Primary
PA167858
OR
Other
Enumeration date
10/17/2013
Last updated
08/30/2023
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