Provider Demographics
NPI:1780971945
Name:KENNEDY, JANINE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:BOYT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MMS
Mailing Address - Street 1:9058 OLD LEE HWY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5631
Mailing Address - Country:US
Mailing Address - Phone:423-531-9110
Mailing Address - Fax:
Practice Address - Street 1:9058 OLD LEE HWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5631
Practice Address - Country:US
Practice Address - Phone:423-531-9110
Practice Address - Fax:423-476-5887
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5741363A00000X
CO3880363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant