Provider Demographics
NPI:1629443668
Name:AKER, KENNA BROOKE (PA)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:BROOKE
Last Name:AKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KENNA
Other - Middle Name:BROOKE
Other - Last Name:HOLTZCLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14215 BALLANTYNE CORPORATE PL STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3671
Practice Address - Country:US
Practice Address - Phone:704-384-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06176363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant