Provider Demographics
NPI:1164565784
Name:KENNETT, JAMES THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:KENNETT
Suffix:
Gender:M
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:RR 4 BOX 156
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9421
Mailing Address - Country:US
Mailing Address - Phone:606-340-2923
Mailing Address - Fax:606-451-9450
Practice Address - Street 1:349 BOGLE ST STE B
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2895
Practice Address - Country:US
Practice Address - Phone:606-451-9448
Practice Address - Fax:606-451-9450
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant