Provider Demographics
NPI:1104663657
Name:SISSON, KENEDY MCCADE
Entity type:Individual
Prefix:MISS
First Name:KENEDY
Middle Name:MCCADE
Last Name:SISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 NEW HIGHWAY 52 E
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-5032
Mailing Address - Country:US
Mailing Address - Phone:615-644-2000
Mailing Address - Fax:
Practice Address - Street 1:1124 NEW HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-5032
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant