Sofia Kenneally, is a medicare enrolled "Physician Assistant" physician in Lakeport, California. She graduated from medical school in 2021 and has 5 years of diverse experience with area of expertise as Physician Assistant. She is a member of the group practice Providence Medical Foundation and her current practice location is
5176 Hill Rd E, Lakeport, California. You can reach out to her office (for appointments etc.) via phone at
(707) 262-5000.
Sofia Kenneally is licensed to practice in California (license number PA60896) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1528718327.
Physician's Profile
| Full Name | Sofia Kenneally |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Experience | 5 Years |
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| Location | 5176 Hill Rd E, Lakeport, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Sofia Kenneally graduated from medical school in 2021
NPI Data:
- NPI Number: 1528718327
- Provider Enumeration Date: 03/25/2022
- Last Update Date: 10/24/2025
Medicare PECOS Information:
- PECOS PAC ID: 8022497106
- Enrollment ID: I20220621000419
Medical Identifiers
Medical identifiers for Sofia Kenneally such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528718327 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207P00000X | Emergency Medicine | 60896 (California) | Secondary |
| 363A00000X | Physician Assistant | PA60896 (California) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Providence Medical Foundation | 8921993205 | 1329 |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sofia Kenneally is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Sofia Kenneally,
Po Box 2741,
Petaluma, CA 94953-2741
Ph: (415) 847-4867 | Sofia Kenneally,
5176 Hill Rd E,
Lakeport, CA 95453-6300
Ph: (707) 262-5000 |
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