Provider Demographics
NPI:1942885017
Name:KENNEDY, GEENA ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GEENA
Middle Name:ROSE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3007 WESLEY CHAPEL STOUTS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-4007
Mailing Address - Country:US
Mailing Address - Phone:919-454-9356
Mailing Address - Fax:
Practice Address - Street 1:3007 WESLEY CHAPEL STOUTS RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-4007
Practice Address - Country:US
Practice Address - Phone:704-412-3612
Practice Address - Fax:704-412-3614
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001011977363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical