Provider Demographics
NPI:1104129634
Name:KENNEY, PATRICK JARRET (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JARRET
Last Name:KENNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1421 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4434
Mailing Address - Country:US
Mailing Address - Phone:954-565-0875
Mailing Address - Fax:954-565-0876
Practice Address - Street 1:1421 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4434
Practice Address - Country:US
Practice Address - Phone:954-565-0875
Practice Address - Fax:954-565-0876
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11063207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHP189ZMedicare PIN