Individual
ANDRE JOHNATHAN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 W HOSPITAL DR, WEST COLUMBIA, SC 29169-3405
(803) 796-8515
(803) 796-8515
Mailing address
9735 KINCEY AVE STE 201, HUNTERSVILLE, NC 28078-9120
(704) 414-2870
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2832
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2832
SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION
SC
Enumeration date
01/31/2018
Last updated
05/26/2021
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