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Individual

ERIN RAE KENNY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Mailing address
1413 MOUNT VERNON RD, CHARLESTON, WV 25314-2531
(304) 415-4645

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
714
WV
363AM0700X
Medical Physician Assistant
Primary
2191
WV
363AM0700X
Medical Physician Assistant
714
WV

Other

Enumeration date
07/05/2016
Last updated
03/23/2022
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