Provider Demographics
NPI:1750848230
Name:KENNEDY, RACHEL MILES (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MILES
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 715868 PHILADELPHIA
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-270-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT66840789OtherDRIVERS LICENSE