Provider Demographics
NPI:1629230982
Name:DALZELL-KENNEY, PAULA J (PA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:DALZELL-KENNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ARSENAL STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0011
Mailing Address - Country:US
Mailing Address - Phone:207-624-4657
Mailing Address - Fax:207-287-6123
Practice Address - Street 1:250 ARSENAL STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0011
Practice Address - Country:US
Practice Address - Phone:207-624-4657
Practice Address - Fax:207-287-6123
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant