Provider Demographics
NPI:1043997513
Name:SCHNEIDER-TRAN, KENNEDY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:
Last Name:SCHNEIDER-TRAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:KENNEDY
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 COLLYER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1869
Mailing Address - Country:US
Mailing Address - Phone:401-272-7799
Mailing Address - Fax:
Practice Address - Street 1:195 COLLYER ST STE 201
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1869
Practice Address - Country:US
Practice Address - Phone:401-272-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1207127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant