Provider Demographics
NPI:1568454437
Name:KENT, JACQUELINE ANN (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANN
Last Name:KENT
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4079 LAKE RD N
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1517
Mailing Address - Country:US
Mailing Address - Phone:585-637-0151
Mailing Address - Fax:585-637-0562
Practice Address - Street 1:4079 LAKE RD N
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1517
Practice Address - Country:US
Practice Address - Phone:585-637-0151
Practice Address - Fax:585-637-0562
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6742363A00000X
NY006742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2605498Medicaid
NY000925083002OtherCOMMUNITY BLUE / WNY
NY109969BFOtherPREFERRED CARE
NYP019006742OtherBLUE CHOICE
PA0665Medicare PIN