Individual
BRIAN KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2721 S SAN TAN VILLAGE PKWY STE 104, GILBERT, AZ 85295-0713
(480) 500-9307
Mailing address
2721 S SAN TAN VILLAGE PKWY STE 104, GILBERT, AZ 85295-0713
(480) 500-9307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8831
AZ
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/24/2019
Last updated
12/06/2021
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