Provider Demographics
NPI:1114926581
Name:KENNEDY, CHRISTINE ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-622-0290
Mailing Address - Fax:
Practice Address - Street 1:575 COAL VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3726
Practice Address - Country:US
Practice Address - Phone:412-267-6500
Practice Address - Fax:412-267-6524
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051305363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071376Medicare ID - Type Unspecified