Provider Demographics
NPI:1922009711
Name:KENNEY, L. CANDIDA (CRNA)
Entity Type:Individual
Prefix:
First Name:L. CANDIDA
Middle Name:
Last Name:KENNEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHESTNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1336
Mailing Address - Country:US
Mailing Address - Phone:724-837-3122
Mailing Address - Fax:724-837-5931
Practice Address - Street 1:20 CHESTNUT HILL DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1336
Practice Address - Country:US
Practice Address - Phone:724-837-3122
Practice Address - Fax:724-837-5931
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN161066L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100118110Medicaid
300067305 1922009711OtherHEALTHNET
OH2533226Medicaid
IN200983120BMedicaid
KY7100118110Medicaid
PAS 15280Medicare UPIN
KY7100118110Medicaid
PA736758Medicare PIN