Provider Demographics
NPI:1174509491
Name:KENNY, PATRICK R (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:KENNY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:121 NATIONWIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-384-1862
Mailing Address - Fax:434-384-7704
Practice Address - Street 1:121 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-384-1862
Practice Address - Fax:434-384-7704
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1001207R00000X
VA0102204930207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174509491Medicaid