Provider Demographics
NPI:1942243522
Name:KENNEY, EDWARD MARTIN (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARTIN
Last Name:KENNEY
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:97 GRANGER ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1110
Practice Address - Country:US
Practice Address - Phone:585-396-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01397153Medicaid
NY019003088OtherEXCELLUS ROCHESTER
NY112342CUOtherPREFERRED CARE
NY01397153Medicaid
NY01397153Medicaid
NY923297001OtherHEALTHNOW