Kennedy, Andre Johnathan

Kennedy, Andre Johnathan is an individual health care provider with primary practice located at 111 W Hospital Dr , West Columbia SC 29169-3405. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Kennedy, Andre Johnathan can be contacted via phone (803) 796-8515.

Contact Information

Primary practice address
111 W Hospital Dr West Columbia SC 29169-3405
Phone: (803) 796-8515
Fax: (803) 796-8515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2832 South Carolina

Profile Details

NPI number 1962900357
LBN Legal business name Kennedy, Andre Johnathan
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 31st, 2018
Last updated May 26th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962900357 NPPES
South Carolina Other 2832 SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION

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