Provider Demographics
NPI:1790986917
Name:KENT, MEREDITH (PA)
Entity Type:Individual
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First Name:MEREDITH
Middle Name:
Last Name:KENT
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Gender:F
Credentials:PA
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Mailing Address - Street 1:555 MIDTOWNE ST NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5729
Mailing Address - Country:US
Mailing Address - Phone:616-588-8880
Mailing Address - Fax:616-588-8881
Practice Address - Street 1:1111 LEFFINGWELL AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6406
Practice Address - Country:US
Practice Address - Phone:616-459-7101
Practice Address - Fax:616-464-6170
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
IL085-002759363AM0700X
MI5601005209363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical