Provider Demographics
NPI:1225090897
Name:KENNEY, ANGELA S (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:KENNEY
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 1:7085 W ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3039
Mailing Address - Country:US
Mailing Address - Phone:623-455-9063
Mailing Address - Fax:
Practice Address - Street 1:8501 N SCOTTSDALE RD
Practice Address - Street 2:STE. 150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-2750
Practice Address - Country:US
Practice Address - Phone:480-946-7939
Practice Address - Fax:480-946-5258
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3215174400000X
AZ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP09909Medicare UPIN
AZWCHBHMedicare ID - Type UnspecifiedSUN CITY & SUN CITY WEST
AZWCKGDMedicare ID - Type UnspecifiedPHOENIX
AZWCKGCMedicare ID - Type UnspecifiedGLENDALE