Basic Information
| Provider Information | |||||||||
| NPI: | 1497037493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578697858 | ||||||||
| FaxNumber: | 7573984420 | ||||||||
| Practice Location | |||||||||
| Address1: | 3636 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578697858 | ||||||||
| FaxNumber: | 7573984420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0021469480 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.