Provider Demographics
NPI:1558530568
Name:KENNEY, SHAWN EDWARD (DMSC, PA-C)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EDWARD
Last Name:KENNEY
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Gender:M
Credentials:DMSC, PA-C
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Mailing Address - Street 1:NAVAL MEDICAL READINESS AND TRAINING COMMAND
Mailing Address - Street 2:2080 CHILD STREET
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214
Mailing Address - Country:US
Mailing Address - Phone:904-542-7460
Mailing Address - Fax:904-542-7835
Practice Address - Street 1:NAVAL MEDICAL READINESS AND TRAINING COMMAND
Practice Address - Street 2:2080 CHILD STREET
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214
Practice Address - Country:US
Practice Address - Phone:904-542-7460
Practice Address - Fax:904-542-7835
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2025-01-30
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07462363A00000X
1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman