Individual
MARIE D. KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2675 CENTRAL AVE, BILLINGS, MT 59102-6686
(406) 238-2500
Mailing address
PO BOX 35100, BILLINGS, MT 59107-5100
(406) 238-2500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
159
MT
363AM0700X
Medical Physician Assistant
Primary
MED-PAC-LIC-159
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000091603
BCBS PIN
MT
01
—
0432769
MDCD PIN
MT
Enumeration date
10/05/2006
Last updated
12/14/2021
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