| Mr Howard Michael Kennedy Jr, PA-C | |
|
4957 Swinyar Dr Ste 109, Ooltewah, TN 37363-2205 | |
| (423) 432-3130 | |
| (423) 396-9508 |
| Full Name | Mr Howard Michael Kennedy Jr |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 4957 Swinyar Dr Ste 109, Ooltewah, Tennessee |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942280052 | NPI | - | NPPES |
| 36660801 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 408 (Tennessee) | Secondary |
| 363A00000X | Physician Assistant | 408 (Tennessee) | Primary |
| Entity Name | The Kennedy Clinic PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508078445 PECOS PAC ID: 2769574219 Enrollment ID: O20070828000948 |
| Entity Name | DX Mso PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1225381148 PECOS PAC ID: 7719131101 Enrollment ID: O20130213000017 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Howard Michael Kennedy Jr, PA-C 4957 Swinyar Dr Ste 109, Ooltewah, TN 37363-2205 Ph: (423) 432-3130 | Mr Howard Michael Kennedy Jr, PA-C 4957 Swinyar Dr Ste 109, Ooltewah, TN 37363-2205 Ph: (423) 432-3130 |
Ashley Rose Lynn, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 8206 Trout Lily Dr, Ooltewah, TN 37363 Phone: 423-475-0924 |
Jessica Bell Groft, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 9463 Pasture Dr, Ooltewah, TN 37363 Phone: 423-653-8836 |
Mrs. Audrey Josey, PA Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 5038 Hunter Rd Ste 102, Ooltewah, TN 37363 Phone: 423-910-6100 Fax: 423-910-6109 |
Virginia Weir, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 6059 Arbury Way, Ooltewah, TN 37363 Phone: 423-238-8880 |
Mrs. Kendyl Rogers Cranston, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6053 Artesian Cir, Ooltewah, TN 37363 Phone: 800-950-0492 |
Kristie Obranovich, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5243 Little Debbie Pkwy Ste 111, Ooltewah, TN 37363 Phone: 423-206-2777 Fax: 423-206-2772 |
Ryan Volking, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 7564 Passport Dr, Ooltewah, TN 37363 Phone: 662-255-9457 |